Provider Demographics
NPI:1780650283
Name:BURRELL, MATTHEW O (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:O
Last Name:BURRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:759 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4317
Mailing Address - Country:US
Mailing Address - Phone:404-300-2379
Mailing Address - Fax:404-300-2379
Practice Address - Street 1:759 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4317
Practice Address - Country:US
Practice Address - Phone:404-300-2379
Practice Address - Fax:404-300-2379
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA017998207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000086589HMedicaid
GA000086589FMedicaid
GA000086589GMedicaid
GA00086589BMedicaid
GA0702361OtherUHC
GA025915OtherBCBS
GA000086589HMedicaid
GA000086589FMedicaid