Individual
TIMOTHY J BURRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2191 SOUTHPORT RD, SPARTANBURG, SC 29306-6257
(864) 215-4840
(864) 583-5485
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32853
SC
207Q00000X
Family Medicine Physician
LL32853
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328531
—
SC
01
—
SC0315
MEDICARE #
SC
01
—
SC03156067
MEDICARE PIN
SC
01
—
SC03156084
MEDICARE PIN
SC
01
—
SC03156121
MEDICARE PIN
SC
01
—
SC0315J577
MEDICARE PIN
SC
Enumeration date
06/16/2010
Last updated
12/08/2020
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