Healthcare Provider Details

I. General information

NPI: 1598316929
Provider Name (Legal Business Name): MADISON BURR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STEVE REYNOLDS BLVD
DULUTH GA
30096-4506
US

IV. Provider business mailing address

3650 STEVE REYNOLDS BLVD
DULUTH GA
30096-4506
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14197505-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: