MEDICARE: LUTHER BURSE JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	043338	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366441438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUTHER BURSE JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7865
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30357-0865
Country	:	US
Telephone Number	:	404-881-8319
Fax Number	:	404-523-6791

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:	SUITE 1750
City	:	ATLANTA
State	:	GA
Zip	:	30308-2208
Country	:	US
Telephone Number	:	404-881-8319
Fax Number	:	404-523-6791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/20/2012

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Directions to “ LUTHER BURSE JR. M.D.” Practice Location

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