Provider Demographics
NPI:1366797391
Name:BURKE, JULIE INEZ (PMH/CNS/NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:INEZ
Last Name:BURKE
Suffix:
Gender:F
Credentials:PMH/CNS/NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:B
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMH/CNS/NP
Mailing Address - Street 1:318 NEWNAN RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3418
Mailing Address - Country:US
Mailing Address - Phone:678-690-1121
Mailing Address - Fax:678-890-1143
Practice Address - Street 1:318 NEWNAN RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3418
Practice Address - Country:US
Practice Address - Phone:678-690-1121
Practice Address - Fax:678-890-1143
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN126100363LP0808X, 364SP0809X
FLAPRN11018901363LP0808X
AL3-000899364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health