Provider Demographics
NPI:1679605158
Name:BURTON, INGRID RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:RENEE
Last Name:BURTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 COBB PKWY SE
Mailing Address - Street 2:SUITE J 260
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4657
Mailing Address - Country:US
Mailing Address - Phone:404-808-7574
Mailing Address - Fax:
Practice Address - Street 1:4355 COBB PKWY SE
Practice Address - Street 2:SUITE J 260
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4657
Practice Address - Country:US
Practice Address - Phone:404-808-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH46659Medicare UPIN
GA11BDTVKMedicare ID - Type Unspecified