Provider Demographics
NPI:1912460692
Name:BURNS, SHERRI OPAL (CSFA)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:OPAL
Last Name:BURNS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 BOLDING RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-3053
Mailing Address - Country:US
Mailing Address - Phone:678-858-2034
Mailing Address - Fax:
Practice Address - Street 1:3911 BOLDING RD
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-3053
Practice Address - Country:US
Practice Address - Phone:678-858-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA246ZC0007ZMedicaid