Healthcare Provider Details

I. General information

NPI: 1427103092
Provider Name (Legal Business Name): GERALD R BURNS MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 ANDREW JACKSON PKWY
HERMITAGE TN
37076-2220
US

IV. Provider business mailing address

4050 ANDREW JACKSON PKWY
HERMITAGE TN
37076-2220
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-2090
  • Fax:
Mailing address:
  • Phone: 615-889-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD5751
License Number StateTN

VIII. Authorized Official

Name: GERALD ROBERT BURNS
Title or Position: PRESIDENT
Credential: MD
Phone: 615-889-2090