Provider Demographics
NPI:1669180741
Name:BURKETT FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:BURKETT FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:912-699-8800
Mailing Address - Street 1:38 S TALLAHASSEE ST STE B
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-6261
Mailing Address - Country:US
Mailing Address - Phone:912-699-8800
Mailing Address - Fax:912-699-8801
Practice Address - Street 1:38 S TALLAHASSEE ST STE B
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6261
Practice Address - Country:US
Practice Address - Phone:912-699-8800
Practice Address - Fax:912-699-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care