Provider Demographics
NPI:1669470316
Name:BURNS, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BURNS
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:PO BOX 746725
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6725
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:2714 UNION AVENUE EXTENDED
Practice Address - Street 2:SUITE 150
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4436
Practice Address - Country:US
Practice Address - Phone:901-725-0872
Practice Address - Fax:901-278-6934
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000017321207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621663939OtherUNITED HEALTH CARE
TNA99130OtherHEALTHSPRINGS
TN164942OtherUNISON
TN3027360Medicaid
TN4093416OtherBLUE CROSS BLUE SHIELD OF TN
TNPOO175298OtherPALMETTO GBA
8824185OtherCIGNA
8824185OtherCIGNA
TNA99130OtherHEALTHSPRINGS