Provider Demographics
NPI:1881958601
Name:JOHNSON, BURLES AVNER III (MD/PHD)
Entity type:Individual
Prefix:DR
First Name:BURLES
Middle Name:AVNER
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MD/PHD
Other - Prefix:
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Mailing Address - Street 1:6201 GREENLEIGH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-2704
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-2423
Practice Address - Fax:706-721-6918
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD79597207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology