Provider Demographics
NPI:1922469766
Name:BURR, ROBERTA (CNA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:BURR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BEAVER CIR
Mailing Address - Street 2:
Mailing Address - City:BRINSON
Mailing Address - State:GA
Mailing Address - Zip Code:39825-1920
Mailing Address - Country:US
Mailing Address - Phone:229-205-2842
Mailing Address - Fax:
Practice Address - Street 1:230 BEAVER CIR
Practice Address - Street 2:
Practice Address - City:BRINSON
Practice Address - State:GA
Practice Address - Zip Code:39825-1920
Practice Address - Country:US
Practice Address - Phone:229-205-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN 0000032703376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide