Provider Demographics
NPI:1629064365
Name:BURTON, ALBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:A
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HARRIS INDUSTRIAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8852
Mailing Address - Country:US
Mailing Address - Phone:912-535-3500
Mailing Address - Fax:912-535-4498
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8852
Practice Address - Country:US
Practice Address - Phone:912-535-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80550207RC0000X, 207RI0011X
GA080550207RC0000X
VA0101058712207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629064365Medicaid
GA80550OtherCARDIOLOGY, INTERVENTIONAL
VA1629064365Medicaid
VA018497R53Medicare PIN