Provider Demographics
NPI:1356314793
Name:BURNETT, JIMENA C (MD)
Entity Type:Individual
Prefix:
First Name:JIMENA
Middle Name:C
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:40 OKATIE CENTER BLVD S STE 100
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7519
Mailing Address - Country:US
Mailing Address - Phone:843-705-8888
Mailing Address - Fax:843-705-7024
Practice Address - Street 1:54 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4952
Practice Address - Country:US
Practice Address - Phone:843-705-8888
Practice Address - Fax:843-705-7024
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC25688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC256886Medicaid
SC656877299OtherWRK. COMP. ID NO.
SCI42550Medicare UPIN
SCAA11148552Medicare ID - Type Unspecified