Healthcare Provider Details

I. General information

NPI: 1508403460
Provider Name (Legal Business Name): JAMES M BURDETTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WESTERN BLVD
JACKSONVILLE NC
28546-6341
US

IV. Provider business mailing address

325 WESTERN BLVD
JACKSONVILLE NC
28546-6341
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-1555
  • Fax:
Mailing address:
  • Phone: 910-577-1555
  • Fax: 910-353-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11222
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: