Provider Demographics
NPI:1770526170
Name:BURKS, JOAN (PA-C)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5473 COBURN CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3035
Mailing Address - Country:US
Mailing Address - Phone:404-597-7359
Mailing Address - Fax:770-394-6748
Practice Address - Street 1:1100 JOHNSON FERRY RD NE STE 425
Practice Address - Street 2:CENTER POINTE I
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1745
Practice Address - Country:US
Practice Address - Phone:404-252-2666
Practice Address - Fax:404-252-0890
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4106363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q01808Medicare UPIN