Provider Demographics
NPI:1750368932
Name:BURNETT, ENID F (MD)
Entity type:Individual
Prefix:DR
First Name:ENID
Middle Name:F
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-422-0213
Mailing Address - Fax:731-660-8319
Practice Address - Street 1:87 MURRAY GUARD DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3775
Practice Address - Country:US
Practice Address - Phone:731-422-0213
Practice Address - Fax:731-660-8319
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0072841207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002497300Medicaid
FL593536402 0011OtherCIGNA
FL070013233OtherRAILROAD MEDICARE
FL2299671OtherGHI
FL41326OtherBLUE CROSS BLUE SHIELD
FL4404822OtherAETNA
FL4404822OtherAETNA
FL002497300Medicaid
FL41326AMedicare PIN
FL2299671OtherGHI