Provider Demographics
NPI:1063221398
Name:BURSH-PUPLAMPU, JILLIAN KIAUNA
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:KIAUNA
Last Name:BURSH-PUPLAMPU
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 1:3065 LOBELLA DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-0500
Mailing Address - Country:US
Mailing Address - Phone:225-226-8892
Mailing Address - Fax:
Practice Address - Street 1:3065 LOBELLA DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-0500
Practice Address - Country:US
Practice Address - Phone:225-226-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty