Provider Demographics
NPI:1891776381
Name:BURNS, ROBERT ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALEXANDER
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 1:1109 BURLEYSON DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2510
Mailing Address - Country:US
Mailing Address - Phone:706-272-6596
Mailing Address - Fax:706-272-6270
Practice Address - Street 1:1109 BURLEYSON DR
Practice Address - Street 2:SUITE 102
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2510
Practice Address - Country:US
Practice Address - Phone:706-272-6596
Practice Address - Fax:706-272-6270
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA024400OtherSTATE MED LIC
GA000263161DMedicaid
D44968Medicare UPIN
GA000263161DMedicaid