Provider Demographics
NPI:1336108141
Name:LINEHAN-BURACK, JEANINE (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:LINEHAN-BURACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3726
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3726
Mailing Address - Country:US
Mailing Address - Phone:706-863-9595
Mailing Address - Fax:706-868-8375
Practice Address - Street 1:3675 J DEWEY GRAY CIR STE 300
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1868
Practice Address - Country:US
Practice Address - Phone:706-863-9595
Practice Address - Fax:706-868-8375
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
FLPA9111128363AS0400X
IDPA-1741363AS0400X
TXPA13075363AS0400X
VA0110007257363AS0400X
TNPA0000004410363AS0400X
NC0010-10111363AS0400X
SCPA1200363AS0400X
GA004463363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA519646861AMedicaid
SC0282PAMedicaid
SC0282PAMedicaid
GA519646861AMedicaid
GA519646861AMedicaid