Provider Demographics
NPI:1629177233
Name:BURTNER, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:BURTNER
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 1:1550 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31207-1554
Mailing Address - Country:US
Mailing Address - Phone:478-301-4111
Mailing Address - Fax:478-301-2387
Practice Address - Street 1:1550 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31207-1554
Practice Address - Country:US
Practice Address - Phone:478-301-4111
Practice Address - Fax:478-301-2387
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080089790OtherRAILROAD MEDICARE
GA000257386AMedicaid
GA000257386AMedicaid