Provider Demographics
NPI:1740029636
Name:BURT, DAWN MARIE (AGNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:BURT
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 DAWSON FOREST RD E STE 120
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0407
Mailing Address - Country:US
Mailing Address - Phone:678-919-2270
Mailing Address - Fax:
Practice Address - Street 1:3651 DAWSON FOREST RD E STE 120
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0407
Practice Address - Country:US
Practice Address - Phone:678-919-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214776363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty