Provider Demographics
NPI:1417294216
Name:BURKE, JAMIE THOMAS (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:THOMAS
Last Name:BURKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEIGH
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6175 NEWTON DR NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2690
Mailing Address - Country:US
Mailing Address - Phone:770-787-6900
Mailing Address - Fax:770-787-6962
Practice Address - Street 1:6175 NEWTON DR NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2690
Practice Address - Country:US
Practice Address - Phone:770-787-6900
Practice Address - Fax:770-787-6962
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant