Provider Demographics
NPI:1205823911
Name:BURNETTE, JOSEPH J (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CHARTER BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4854
Mailing Address - Country:US
Mailing Address - Phone:478-330-6755
Mailing Address - Fax:478-330-6759
Practice Address - Street 1:420 CHARTER BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4854
Practice Address - Country:US
Practice Address - Phone:478-330-6755
Practice Address - Fax:478-330-6759
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA033286208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126405AMedicaid
GA02BDBKHMedicare ID - Type UnspecifiedMEDICARE
GA003126405AMedicaid