Provider Demographics
NPI:1790184091
Name:BURNETTE, JULIANA JEAN (LDN)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:JEAN
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 BRAINERD RD
Mailing Address - Street 2:208
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5310
Mailing Address - Country:US
Mailing Address - Phone:423-227-2202
Mailing Address - Fax:423-265-1364
Practice Address - Street 1:5616 BRAINERD RD
Practice Address - Street 2:208
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5310
Practice Address - Country:US
Practice Address - Phone:423-227-2202
Practice Address - Fax:423-265-1364
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001243133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered