DR. JASON ODELL BURNETTE (NPI# 1467614149) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467614149 |
| Entity Type | Individual |
| Full Name | DR. JASON ODELL BURNETTE |
| Credential | M.D. |
| Practice Address |
100 Mimosa Dr Thomasville GA 31792-6676 |
| Mailing Address |
900 Cairo Rd Thomasville GA 31792-4255 |
| Practice Telephone | 2292285500 |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2020-08-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 069097 | GA | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 003111 | GA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1120 15th St, Augusta, GA 309120004 | 7067212519 |
| Street Address |
100 MIMOSA DR |
| City | THOMASVILLE |
| State | GA |
| Zip Code | 31792-6676 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073597753 | Timothy G Grayson | Urology | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2005-12-06 |
| 1902397672 | Fran Maureen Johnson | Physician Assistant | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2018-05-29 |
| 1619336898 | Archbold Medical Group, Inc. | Urology | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2016-02-17 |
| 1568862068 | Bianca Kierce | Nurse Practitioner | 100 Mimosa Dr, Third Floor, Thomasville, GA 31792-6676 | 2014-09-03 |
| 1871929364 | Leslie C. Stanaland | Nurse Practitioner | 100 Mimosa Dr, 2nd Floor, Thomasville, GA 31792-6676 | 2013-09-17 |
| 1619242781 | Krystyn Riddle | Physician Assistant | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2012-03-21 |
| 1649543497 | Kelly M Ledger | Nurse Practitioner | 100 Mimosa Dr, 2nd Floor, Thomasville, GA 31792-6676 | 2012-02-09 |
| 1205119005 | Ivey E. Allen | Physician Assistant | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2011-09-28 |
| 1598057655 | Archbold Medical Group | Surgery | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2011-05-09 |
| 1760771356 | Mary Kathryn Hanisee | Surgery | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2011-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245739879 | Georgia Pines Community Service Board | Community/Behavioral Health | 407 Cloverdale Drive, Thomasville, GA 31792 | 2018-02-09 |
| 1932613551 | Diana Diaz | Physician Assistant | 2705 E Pinetree Blvd Ste A, Thomasville, GA 31792 | 2017-11-17 |
| 1194249425 | Bobbie Frazier | Contractor | 400 Cloverdale Dr, Thomasville, GA 31792 | 2017-07-28 |
| 1598132292 | Southern Scripts, LLC | Pharmacy | 501 Gordon Avenue, Thomasville, GA 31792 | 2015-08-28 |
| 1508248915 | Elizabeth Nicole Keen | Behavioral Analyst | 121 Covington Ave Apt 9, Thomasville, GA 31792 | 2015-06-22 |
| 1417341579 | Sheila L Stanley | Counselor | 301 Summercreek Cove, Thomasville, GA 31792 | 2015-03-26 |
| 1457749301 | Ashley Lamb | Speech-Language Pathologist | 1203 East Jackson Street, Thomasville, GA 31792 | 2014-12-30 |
| 1831403880 | Somnoquest | Durable Medical Equipment & Medical Supplies | 556 Hall Road, Thomasville, GA 31792 | 2010-08-02 |
| 1508000183 | Kashyap B Choksi | Internal Medicine | 100 Mimosa Drive 2nd Floor, Thomasville, GA 31792 | 2009-04-27 |
| 1205008786 | Mark J Glaccum | Chiropractor | 415 Gordon Avenue, Thomasville, GA 31792 | 2008-03-25 |
| Find all providers in zip 31792 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508186834 | Forsyth Medical Group, LLC | Urology | 1219 Lexington Ave Ste D, Thomasville, NC 27360-2784 | 2010-06-09 |
| 1801906433 | Frank Eugene Glover Jr. | Urology | 817 Smith Ave, Thomasville, GA 31792 | 2006-08-30 |
| 1073597753 | Timothy G Grayson | Urology | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2005-12-06 |
| 1619336898 | Archbold Medical Group, Inc. | Urology | 100 Mimosa Dr, Thomasville, GA 31792-6676 | 2016-02-17 |
| 1154503472 | The Urology Institute and Continence Center,pc | Urology | 817 Smith Ave, Thomasville, GA 31792-5643 | 2007-11-28 |
| 1033282231 | South Georgia Urology Group, P. C. | Urology | 116 Mimosa Dr, Suite 2, Thomasville, GA 31792-6605 | 2006-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942820576 | Advanced Urology Institute of Georgia PC | Urology | 2205 Riverstone Blvd Ste 101, Canton, GA 30114-5250 | 2020-04-23 |
| 1093369795 | Georgia Urology, Pa | Urology | 470 Northside Cherokee Blvd Ste 210, Canton, GA 30115-8029 | 2019-07-31 |
| 1790248953 | Michael Oberle | Urology | 1120 15th St Rm Baa 8415, Augusta, GA 30912-4050 | 2019-04-12 |
| 1598220915 | Effingham Urology, LLC | Urology | 613 Towne Park Dr W Ste 204, Rincon, GA 31326-5183 | 2019-02-11 |
| 1275008351 | Center for Special Surgery LLC | Urology | 11660 Alpharetta Hwy Ste 720, Roswell, GA 30076-4916 | 2018-10-04 |
| 1295200426 | Paul Edward Henson Jr. | Urology | 1837 Wood Valley Dr, Dalton, GA 30720-3846 | 2018-10-03 |
| 1477033124 | Urological Health Center, PC | Urology | 1770 Watson Boulevard, Warner Robins, GA 31093 | 2018-08-21 |
| 1982182655 | Advanced Urology Institute of Georgia | Urology | 1460 S Johnson Ferry Rd, Atlanta, GA 30319-4301 | 2018-08-03 |
| 1922597517 | Wguasc, LLC | Urology | 150 Clinic Ave Ste 203, Carrollton, GA 30117-4402 | 2018-05-09 |
| 1841788395 | Houston Physician Specialists, LLC | Urology | 233 N Houston Rd Ste 100, Warner Robins, GA 31093-8944 | 2018-04-30 |
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| City | THOMASVILLE |
| Zip Code | 31792 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.