Provider Demographics
NPI:1821101783
Name:BURDETT, DAVID L (RT, MR)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:BURDETT
Suffix:
Gender:M
Credentials:RT, MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 WATSON BLVD
Mailing Address - Street 2:APT 708
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6565
Mailing Address - Country:US
Mailing Address - Phone:478-955-2349
Mailing Address - Fax:
Practice Address - Street 1:1504 HARDEMAN AVE
Practice Address - Street 2:STE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1416
Practice Address - Country:US
Practice Address - Phone:478-745-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
340833247100000X, 2471C3402X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging