Provider Demographics
NPI:1780013805
Name:BURCH, KATELYN (CPNP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5461 MERIDIAN MARK RD STE 520
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3283
Mailing Address - Country:US
Mailing Address - Phone:404-785-2900
Mailing Address - Fax:404-785-2930
Practice Address - Street 1:5461 MERIDIAN MARK RD STE 520
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3283
Practice Address - Country:US
Practice Address - Phone:404-785-2900
Practice Address - Fax:404-785-2930
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN223487363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics