Individual
DR. CHARLES ROLAND BURNETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
80 HUMPHREYS CTR, SUITE 202, MEMPHIS, TN 38120-2361
(901) 747-3330
(901) 747-3245
Mailing address
80 HUMPHREYS CTR, SUITE 202, MEMPHIS, TN 38120-2361
(901) 747-3330
(901) 747-3245
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
C-5269
AR
207RC0000X
Cardiovascular Disease Physician
Primary
MD014125
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000039811
TLC
TN
05
—
00013823
—
MS
01
—
102G26
MO BLUE CROSS
MO
05
—
107284001
—
AR
05
—
202043303
—
MO
05
—
3194515
—
TN
01
—
4118485
AETNA
TN
01
—
4146198
BCBS
TN
01
—
62116765701
QUALCHOICE
—
01
—
81185
BCBS
AR
01
—
P00372263
RAIL ROAD MEDICARE
MS
01
—
P00378334
RAIL ROAD MEDICARE
TN
Enumeration date
05/23/2005
Last updated
11/19/2011
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