Provider Demographics
NPI:1508821067
Name:BURNS, JAMES BRACKEN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRACKEN
Last Name:BURNS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DOGWOOD AVE, BLDG #1
Mailing Address - Street 2:ROOM 2-42
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614
Mailing Address - Country:US
Mailing Address - Phone:423-439-6263
Mailing Address - Fax:
Practice Address - Street 1:DOGWOOD AVE, BLDG #1
Practice Address - Street 2:ROOM 2-42
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614
Practice Address - Country:US
Practice Address - Phone:423-439-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008439208600000X
TN2911208600000X, 2086S0127X
OH35-0084392086S0127X
FLOS101052086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2784823-00Medicaid
OH2650448Medicaid
VA1508821067Medicaid
GA428749571AMedicaid
TNQ016851Medicaid
GA428749571AMedicaid
FL2784823-00Medicaid
VA1508821067Medicaid
FLAE428ZMedicare PIN