Provider Demographics
NPI:1225233729
Name:BURNETT, WILLIAM ELTON (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELTON
Last Name:BURNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2720 MALL OF GEORGIA BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8761
Mailing Address - Country:US
Mailing Address - Phone:404-697-6695
Mailing Address - Fax:678-957-0887
Practice Address - Street 1:2150 BOGGS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5890
Practice Address - Country:US
Practice Address - Phone:404-697-6695
Practice Address - Fax:678-957-0887
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2009-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA020413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00208392AMedicaid
GAE54844Medicare UPIN