MEDICARE: DR. DONNA E BURRELL M.D.

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	207R00000X	Internal Medicine Physician	38704	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20211I1194	OTHER	GA	MEDICARE PTAN
2	110088-488	OTHER	GA	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891782066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA E BURRELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9247
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31908-9247
Country	:	US
Telephone Number	:	706-322-7884
Fax Number	:	706-660-2118

Provider Business Practice Location Address
First Line	:	610 19TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1528
Country	:	US
Telephone Number	:	706-322-7884
Fax Number	:	706-660-2118

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/31/2015

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Directions to “ DR. DONNA E BURRELL M.D.” Practice Location

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