MEDICARE: MADISON BURR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	14197505-1206	UT

General Provider Information

NPI Number	:	1598316929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON BURR PA-C

Provider Business Mailing Address
First Line	:	3650 STEVE REYNOLDS BLVD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 STEVE REYNOLDS BLVD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4506
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	12/29/2025

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Directions to “ MADISON BURR PA-C” Practice Location

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