Basic Information
| Provider Information | |||||||||
| NPI: | 1669470316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746725 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303746725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127339730 | ||||||||
| FaxNumber: | 3129290373 | ||||||||
| Practice Location | |||||||||
| Address1: | 2714 UNION AVENUE EXTENDED | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381124436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017250872 | ||||||||
| FaxNumber: | 9012786934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 01/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | MD0000017321 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 621663939 | 01 | TN | UNITED HEALTH CARE | OTHER | A99130 | 01 | TN | HEALTHSPRINGS | OTHER | 164942 | 01 | TN | UNISON | OTHER | 3027360 | 05 | TN | MEDICAID | 4093416 | 01 | TN | BLUE CROSS BLUE SHIELD OF TN | OTHER | POO175298 | 01 | TN | PALMETTO GBA | OTHER | 8824185 | 01 | CIGNA | OTHER |