Provider Demographics
NPI:1679192819
Name:BURNEY, DEMETRIS
Entity Type:Individual
Prefix:
First Name:DEMETRIS
Middle Name:
Last Name:BURNEY
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 1:6344 DESHONG DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6123
Mailing Address - Country:US
Mailing Address - Phone:404-219-4404
Mailing Address - Fax:
Practice Address - Street 1:1170 PEACHTREE ST NE STE 1200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-7673
Practice Address - Country:US
Practice Address - Phone:404-219-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician