Provider Demographics
NPI:1437292620
Name:BURNS, ROBERTA RAINEY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:RAINEY
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:FRANCES
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1724 HARNESS PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8122
Mailing Address - Country:US
Mailing Address - Phone:615-370-0069
Mailing Address - Fax:
Practice Address - Street 1:95 WHITE BRIDGE RD
Practice Address - Street 2:SUITE 219
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1497
Practice Address - Country:US
Practice Address - Phone:615-356-1666
Practice Address - Fax:888-239-5081
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000041194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DED01174Medicare UPIN