Healthcare Provider Details

I. General information

NPI: 1609901198
Provider Name (Legal Business Name): CLAUDE A BURNETT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N HARRIS ST
ATHENS GA
30601-2411
US

IV. Provider business mailing address

220 RESEARCH DR
ATHENS GA
30605-2738
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-8600
  • Fax: 706-542-9754
Mailing address:
  • Phone: 706-583-2870
  • Fax: 706-548-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number016885
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: