Provider Demographics
NPI:1831136928
Name:BURNETT, ALISA JOYCE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:JOYCE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:6945 DEER CREEK TRCE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5477
Mailing Address - Country:US
Mailing Address - Phone:404-918-1915
Mailing Address - Fax:678-267-2865
Practice Address - Street 1:4221 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7316
Practice Address - Country:US
Practice Address - Phone:478-368-5385
Practice Address - Fax:478-910-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist