Provider Demographics
NPI:1578347720
Name:BURKLE, ANDREA (PAC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BURKLE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 UPPER RIVERDALE RD SE STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2635
Mailing Address - Country:US
Mailing Address - Phone:678-904-0094
Mailing Address - Fax:678-904-0098
Practice Address - Street 1:34 UPPER RIVERDALE RD SE STE 201
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2635
Practice Address - Country:US
Practice Address - Phone:678-904-0094
Practice Address - Fax:678-904-0098
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant