Healthcare Provider Details

I. General information

NPI: 1083798904
Provider Name (Legal Business Name): BRENT ALAN BURNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4431 HWY 220 N
SUMMERFIELD NC
27358-9411
US

IV. Provider business mailing address

1701 WESTCHESTER DR STE 850
HIGH POINT NC
27262-7254
US

V. Phone/Fax

Practice location:
  • Phone: 336-643-7711
  • Fax: 336-643-3047
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: