Provider Demographics
NPI:1427103092
Name:GERALD R BURNS MDPC
Entity type:Organization
Organization Name:GERALD R BURNS MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-889-2090
Mailing Address - Street 1:4050 ANDREW JACKSON PKWY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2220
Mailing Address - Country:US
Mailing Address - Phone:615-889-2090
Mailing Address - Fax:
Practice Address - Street 1:4050 ANDREW JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2220
Practice Address - Country:US
Practice Address - Phone:615-889-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD5751261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNBO3736Medicare UPIN
3381502Medicare ID - Type Unspecified