Provider Demographics
NPI:1841252525
Name:MCBURNEY, JOHN W (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:MCBURNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:505-272-3100
Mailing Address - Fax:
Practice Address - Street 1:BON SECOURS NEUROLOGY
Practice Address - Street 2:801 ROPER CREEK DRIVE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6938
Practice Address - Country:US
Practice Address - Phone:864-516-1170
Practice Address - Fax:877-249-9483
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC220532084N0402X, 2084N0400X, 2084N0400X, 2084N0402X
PAMD4279922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038845Medicaid
OR500675047Medicaid
SCP00822413OtherRR MEDICARE
SCT63222Medicaid
WA2038845Medicaid
SCC789043640Medicare PIN
SCP00822413OtherRR MEDICARE