Provider Demographics
NPI:1538102611
Name:BURNETTE, CAROL WALDREP (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:WALDREP
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1209
Mailing Address - Country:US
Mailing Address - Phone:864-225-3551
Mailing Address - Fax:864-328-0328
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:SUITE 1260
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2067
Practice Address - Country:US
Practice Address - Phone:864-225-3551
Practice Address - Fax:864-328-0328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19980207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G91117Medicare UPIN