Provider Demographics
NPI:1659332344
Name:BURNETTE, J P (MD, FACP)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:P
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:MD, FACP
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 3069
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-3069
Mailing Address - Country:US
Mailing Address - Phone:252-237-2700
Mailing Address - Fax:252-237-5034
Practice Address - Street 1:2130 FOREST HILLS RD W
Practice Address - Street 2:STE B
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3681
Practice Address - Country:US
Practice Address - Phone:252-237-2700
Practice Address - Fax:252-237-5034
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920191Medicaid
NC20191OtherBCBS
NC20191OtherBCBS
NC205163BMedicare ID - Type Unspecified