Provider Demographics
NPI:1952514226
Name:BURNETTE, AUTUMN FORD (MD)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:FORD
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:SUITE 2303 TOWER BUILDING
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-6723
Mailing Address - Fax:202-865-1888
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:SUITE 2303 TOWER BUILDING
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-6723
Practice Address - Fax:202-865-1888
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241760207RA0201X
DCMD042114207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952514226Medicaid