Provider Demographics
NPI:1164461604
Name:BURT, HEATHER (CRNA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 FELTON HILL RD SW
Mailing Address - Street 2:STE 100
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3522
Mailing Address - Country:US
Mailing Address - Phone:770-333-7888
Mailing Address - Fax:770-333-7889
Practice Address - Street 1:6815 NOBLE AVE STE 400
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-6516
Practice Address - Country:US
Practice Address - Phone:818-901-6690
Practice Address - Fax:818-901-6699
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA07270207L00000X
CA3162207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2380927Medicaid
OHBU8231415Medicare ID - Type Unspecified