Provider Demographics
NPI:1497960975
Name:BURKS, CHESTER A (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:A
Last Name:BURKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4775 JIMMY CARTER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:770-638-8446
Mailing Address - Fax:770-806-0901
Practice Address - Street 1:4775 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093
Practice Address - Country:US
Practice Address - Phone:770-638-8446
Practice Address - Fax:770-806-0901
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA33542207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF16478Medicare UPIN