Provider Demographics
NPI:1538365515
Name:BURNSIDE II, EDWARD HALE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HALE
Last Name:BURNSIDE II
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 1:220 WARM SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8065
Mailing Address - Country:US
Mailing Address - Phone:478-445-6111
Mailing Address - Fax:
Practice Address - Street 1:396 LAWERANCE RD
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:478-445-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine