Provider Demographics
NPI:1740352327
Name:BURNETT, SARAH M (MS, RD, L,D)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:M
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MS, RD, L,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 NEW LIBERTY TRL
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30536-4755
Mailing Address - Country:US
Mailing Address - Phone:706-273-6999
Mailing Address - Fax:
Practice Address - Street 1:59 NEW LIBERTY TRL
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30536-4755
Practice Address - Country:US
Practice Address - Phone:706-273-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002697133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered