Provider Demographics
| NPI: | 1487205753 |
|---|---|
| Name: | BURKS, CASSAUNDRA A (DA,CPC,PCT,DH,MA,CET) |
| Entity Type: | Individual |
| Prefix: | |
| First Name: | CASSAUNDRA |
| Middle Name: | A |
| Last Name: | BURKS |
| Suffix: | |
| Gender: | F |
| Credentials: | DA,CPC,PCT,DH,MA,CET |
| Other - Prefix: | |
| Other - First Name: | CASSAUNDRA |
| Other - Middle Name: | A |
| Other - Last Name: | DEWBERRY |
| Other - Suffix: | |
| Other - Last Name Type: | Former Name |
| Other - Credentials: | DA,CPC,PCT,DH,MA,CET |
| Mailing Address - Street 1: | 3904 WELHAM GREEN CT |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DOUGLASVILLE |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 30135-7236 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 678-666-2545 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 3904 WELHAM GREEN CT |
| Practice Address - Street 2: | |
| Practice Address - City: | DOUGLASVILLE |
| Practice Address - State: | GA |
| Practice Address - Zip Code: | 30135-7236 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 678-666-2545 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2019-09-26 |
| Last Update Date: | 2022-12-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| GA | 106S00000X, 246RP1900X | |
| 124Q00000X, 246QB0000X, 246QC1000X, 246QI0000X, 246R00000X, 246RH0600X, 246W00000X, 246QH0401X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 246QH0401X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Hemapheresis Practitioner |
| No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | |
| No | 124Q00000X | Dental Providers | Dental Hygienist | |
| No | 246QB0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Blood Banking |
| No | 246QC1000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Chemistry |
| No | 246QI0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Immunology |
| No | 246R00000X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | |
| No | 246RH0600X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Histology |
| No | 246RP1900X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy |
| No | 246W00000X | Technologists, Technicians & Other Technical Service Providers | Technician, Cardiology |
