Provider Demographics
NPI:1407838899
Name:BURGESS, WILLIAM C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:BURGESS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-6901
Mailing Address - Fax:704-384-6902
Practice Address - Street 1:1401 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5402
Practice Address - Country:US
Practice Address - Phone:704-384-6901
Practice Address - Fax:704-384-6902
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920004Medicaid
SCN33796Medicaid
NC8920004Medicaid
SCN33796Medicaid