Provider Demographics
NPI:1437142122
Name:BURNS, TINA K (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:K
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-0881
Mailing Address - Fax:901-516-0528
Practice Address - Street 1:7655 POPLAR AVE
Practice Address - Street 2:BLDG A, SUITE 155
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3957
Practice Address - Country:US
Practice Address - Phone:901-752-2300
Practice Address - Fax:901-516-1391
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN16158207Q00000X
MS10707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2660497OtherCIGNA
TN4041152OtherAETNA
TN4344868OtherBCBS
TN4041152OtherAETNA