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Individual

DR. FRED M. BURDETTE III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1920 WARM SPRINGS RD, STE 1009, COLUMBUS, GA 31904-8031
(706) 596-8200
(706) 571-0207
Mailing address
1920 WARM SPRINGS RD, COLUMBUS, GA 31904-8031
(706) 596-8200
(706) 571-0207

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
018618
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000151093K
GA
05
154326
AL
01
202I782712
MEDICARE PTAN
GA
Enumeration date
05/05/2006
Last updated
11/30/2016
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