1669470316 NPI number — ROBERT BURNS M.D.

Table of content: ROBERT BURNS M.D. (NPI 1669470316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669470316 NPI number — ROBERT BURNS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669470316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-6725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-733-9730
Provider Business Mailing Address Fax Number:
312-929-0373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2714 UNION AVENUE EXTENDED
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38112-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-725-0872
Provider Business Practice Location Address Fax Number:
901-278-6934
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  MD0000017321 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 621663939 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: A99130 . This is a "HEALTHSPRINGS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 164942 . This is a "UNISON" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3027360 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4093416 . This is a "BLUE CROSS BLUE SHIELD OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: POO175298 . This is a "PALMETTO GBA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8824185 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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