Healthcare Provider Details

I. General information

NPI: 1942288618
Provider Name (Legal Business Name): JOHN A'HEARN BURDETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N HOWE ST
SOUTHPORT NC
28461-3099
US

IV. Provider business mailing address

924 N HOWE ST
SOUTHPORT NC
28461-3099
US

V. Phone/Fax

Practice location:
  • Phone: 910-457-4739
  • Fax:
Mailing address:
  • Phone: 304-610-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3801
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14099
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: