Provider Demographics
NPI:1134927999
Name:BURRELL, JEANNIE THOMPSON (RPH)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:THOMPSON
Last Name:BURRELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 BANKS ST
Mailing Address - Street 2:
Mailing Address - City:LULA
Mailing Address - State:GA
Mailing Address - Zip Code:30554-5114
Mailing Address - Country:US
Mailing Address - Phone:770-869-3616
Mailing Address - Fax:770-869-9080
Practice Address - Street 1:6102 BANKS ST
Practice Address - Street 2:
Practice Address - City:LULA
Practice Address - State:GA
Practice Address - Zip Code:30554-5114
Practice Address - Country:US
Practice Address - Phone:770-869-3616
Practice Address - Fax:770-869-9080
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist