Healthcare Provider Details

I. General information

NPI: 1174508808
Provider Name (Legal Business Name): EDWARD BRANTLEY BURNS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 W CLINCH AVE STE 100
KNOXVILLE TN
37916
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-5365
  • Fax: 865-673-8007
Mailing address:
  • Phone: 865-694-0062
  • Fax: 865-694-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number19574
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: