Provider Demographics
NPI:1891706768
Name:BURKE, CHARLES C (M D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:BURKE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 540
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30560-0540
Mailing Address - Country:US
Mailing Address - Phone:706-374-6898
Mailing Address - Fax:706-374-5006
Practice Address - Street 1:1008 N. 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2029
Practice Address - Country:US
Practice Address - Phone:718-471-0700
Practice Address - Fax:718-471-0055
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152906207R00000X
GA058876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE39403Medicare UPIN
NY27N172Medicare ID - Type Unspecified