Provider Demographics
NPI:1326129172
Name:BURT, CASSIE LUCIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CASSIE
Middle Name:LUCIA
Last Name:BURT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:404-223-0792
Mailing Address - Fax:404-223-5815
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1185
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-223-0792
Practice Address - Fax:404-223-5815
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004974363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA654954768N, OMedicaid
GACA9328OtherMEDICARE GROUP-DMERC
GACA9328OtherMEDICARE GROUP-DMERC