Provider Demographics
NPI:1417796848
Name:BURNETT-HINDSMAN, KEAIR SHAWAN
Entity type:Individual
Prefix:
First Name:KEAIR
Middle Name:SHAWAN
Last Name:BURNETT-HINDSMAN
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 1:1922 PAIR RD SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-5909
Mailing Address - Country:US
Mailing Address - Phone:678-532-4396
Mailing Address - Fax:
Practice Address - Street 1:1922 PAIR RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-5909
Practice Address - Country:US
Practice Address - Phone:678-532-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical