Provider Demographics
NPI:1568424133
Name:BURNETT, TODD DAVID (MDIV, PSYD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DAVID
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MDIV, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 OLDE TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3195
Mailing Address - Country:US
Mailing Address - Phone:912-341-7060
Mailing Address - Fax:912-356-2691
Practice Address - Street 1:1915 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5027
Practice Address - Country:US
Practice Address - Phone:912-351-6502
Practice Address - Fax:912-356-2691
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007868103TC0700X
GAPSY003467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical