Provider Demographics
NPI:1174353544
Name:BURHENN, CHARIS (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:
Last Name:BURHENN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 LANGFORD DR BLDG 400-103
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7370
Mailing Address - Country:US
Mailing Address - Phone:706-521-8413
Mailing Address - Fax:706-521-8354
Practice Address - Street 1:1747 LANGFORD DRIVE
Practice Address - Street 2:BUILDING 400, SUITE 103
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7310
Practice Address - Country:US
Practice Address - Phone:706-521-8413
Practice Address - Fax:706-521-8354
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily