Provider Demographics
NPI:1831162106
Name:BURNS, JAMES MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:BURNS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BRACKETT RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3864
Mailing Address - Country:US
Mailing Address - Phone:770-427-4545
Mailing Address - Fax:770-426-0502
Practice Address - Street 1:800 BRACKETT RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3864
Practice Address - Country:US
Practice Address - Phone:770-427-4545
Practice Address - Fax:770-426-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55442754SAMedicare PIN
GA0770690001Medicare NSC
U20075Medicare UPIN