Provider Demographics
NPI:1336265727
Name:BURNS, ANN
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:BURNS
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 1:310 W GORDON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-3258
Mailing Address - Country:US
Mailing Address - Phone:229-432-7839
Mailing Address - Fax:229-434-9873
Practice Address - Street 1:310 W GORDON AVE STE D
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-3258
Practice Address - Country:US
Practice Address - Phone:229-432-7839
Practice Address - Fax:229-434-9873
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE006693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00332604AMedicaid