Individual provider Active NPI

Sandra W Burns, P. A.

  • Physician Assistant
  • Dalton, GA
National Provider Identifier
1578625331
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
000988 Issued in GA
Practice address
900 Shugart Rd
Dalton, GA 30720-2467
Phone
(706) 270-5100
Fax
(706) 270-5066
NPI assigned
Dec 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 000988 GA Primary
Child & Adolescent Psychiatric/Mental Health Registered Nurse 163WP0807X RN026508 GA

Addresses

Primary practice location

900 Shugart Rd
Dalton, GA 30720-2467

Mailing address

1401 Applewood Dr
Suite 1
Dalton, GA 30720-2699
Phone (706) 270-5003

Other identifiers 1

IdentifierTypeStateIssuer
000988OtherGALICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
RN026508GAMDChild & Adolescent Psychiatric/Mental Health Registered Nurse
000988GAMDPhysician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315526400000",
    "number": "1578625331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 APPLEWOOD DR",
            "address_2": "SUITE 1",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202699",
            "telephone_number": "706-270-5003",
            "fax_number": "706-270-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SHUGART RD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202467",
            "telephone_number": "706-270-5100",
            "fax_number": "706-270-5066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNS",
        "first_name": "SANDRA",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "P. A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-15",
        "last_updated": "2011-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "000988",
            "primary": true
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "GA",
            "license": "RN026508",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "000988",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.