Provider Demographics
NPI:1669166195
Name:BURCHETTE, MAEBELL
Entity type:Individual
Prefix:
First Name:MAEBELL
Middle Name:
Last Name:BURCHETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 PEBBLE STONE PL
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4990
Mailing Address - Country:US
Mailing Address - Phone:229-256-6146
Mailing Address - Fax:
Practice Address - Street 1:312 PEBBLE STONE PL
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4990
Practice Address - Country:US
Practice Address - Phone:229-256-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor