Healthcare Provider Details

I. General information

NPI: 1518159417
Provider Name (Legal Business Name): WILLIAM EDWARD BURAK JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE SUITE 405
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

4700 WATERS AVE STE 405
SAVANNAH GA
31404-6220
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-2700
  • Fax: 912-350-2715
Mailing address:
  • Phone: 912-350-2700
  • Fax: 912-350-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number068527
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35.063903
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number068527
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: