Provider Demographics
NPI:1619592284
Name:BURNS, EMILY HEAPE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:HEAPE
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SHALLOWFORD RD NE APT 2102
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1218
Mailing Address - Country:US
Mailing Address - Phone:770-375-5858
Mailing Address - Fax:
Practice Address - Street 1:619 S 8TH ST STE 200
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4260
Practice Address - Country:US
Practice Address - Phone:770-227-1587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant