Provider Demographics
NPI:1255374278
Name:ABBY BURR, DIANE (DO)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:ABBY BURR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 ADAMSON SQUARE
Mailing Address - Street 2:STE 6
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-1816
Mailing Address - Country:US
Mailing Address - Phone:770-836-1178
Mailing Address - Fax:
Practice Address - Street 1:402 ADAMSON SQUARE
Practice Address - Street 2:STE 6
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-1816
Practice Address - Country:US
Practice Address - Phone:700-836-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00067207R00000X, 208M00000X
MI101009860207R00000X
TN1823207R00000X
GA60148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF07675Medicare UPIN