Individual provider Active NPI

Mark Lloyd Burson, M.D.

  • Urology Physician
  • Macon, GA
National Provider Identifier
1104808229
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
36112 Issued in GA
Practice address
330 Hospital Dr Ste 315
Macon, GA 31217-8042
Phone
(478) 742-5331
NPI assigned
Nov 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 0101265824 VA
Urology Physician 208800000X CDR.0004667 CO
Urology Physician 208800000X 40439 TN
Urology Physician 208800000X 36112 GA Primary

Addresses

Primary practice location

330 Hospital Dr Ste 315
Macon, GA 31217-8042

Mailing address

330 Hospital Dr Ste 315
Macon, GA 31217-8042

Other practice location 1

1802 Braeburn Dr
Salem, VA 24153-7357
Phone (540) 772-3702

Other practice location 2

107 Ledford Mill Rd
Tullahoma, TN 37388-2278
Phone (931) 454-1955

Other practice location 3

1010 Three Springs Blvd Ste 270
Durango, CO 81301-8296
Phone (970) 764-3845

Other identifiers 1

IdentifierTypeStateIssuer
4116328OtherTNBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA, AL, VA, MI5 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20060103000406 TN Practitioner - Urology 7113949728 Reassigns benefits to 1 organization
I20060406000066 GA Practitioner - Urology 7113949728 Reassigns benefits to 1 organization
I20151202000364 AL Practitioner - Urology 7113949728 Reassigns benefits to 1 organization
I20190507002859 VA Practitioner - Urology 7113949728 Reassigns benefits to 1 organization
I20220711002591 MI Practitioner - Urology 7113949728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Providers LLCGroup PAC ID 9830082825, 526 clinicians

Practice addresses (Care Compare)

330 Hospital Dr
Suite 315
Macon, GA 31217-8042
Phone (478) 742-5331

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
CDR.0004667COMDUrology Physician
36112GAMDUrology Physician
40439TNMDUrology Physician
0101265824VAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices CurrentSince Jun 28, 2022 Accepting new patients
Lewis Gale Physicians LLC CurrentSince Feb 24, 2019 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Apr 1, 2026 Accepting new patients
Wiregrass Clinic LLC Urology CurrentSince Sep 17, 2025 Accepting new patients
Lakeland Medical Practices CurrentSince Jun 28, 2022 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Apr 1, 2026 Accepting new patients
Urology of Greater Atlanta LLC Past Accepting new patients

Locations

4300 W Main St
Ste 21
Dothan, AL 36305
Phone (334) 699-7900

815 Saint Joseph Dr
Saint Joseph, MI 49085
Phone (269) 982-4272

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

1 Medical Park Blvd
Ste 210E
Bristol, TN 37620
Phone (423) 224-4000

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

1802 Braeburn Dr
Salem, VA 24153
Phone (540) 772-3400

Interoperability endpoints

  • Direct secure messaging: mark.burson@hca5.eclinicaldirectplus.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1104808229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 HOSPITAL DR STE 315",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312178042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 HOSPITAL DR STE 315",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312178042",
            "telephone_number": "478-742-5331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1802 Braeburn Dr",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "VA",
            "postal_code": "241537357",
            "country_code": "US",
            "telephone_number": "540-772-3702",
            "fax_number": "540-772-3703",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "107 Ledford Mill Rd",
            "address_purpose": "LOCATION",
            "city": "Tullahoma",
            "state": "TN",
            "postal_code": "373882278",
            "country_code": "US",
            "telephone_number": "931-454-1955",
            "fax_number": "931-454-1956",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1010 Three Springs Blvd Ste 270",
            "address_purpose": "LOCATION",
            "city": "Durango",
            "state": "CO",
            "postal_code": "813018296",
            "country_code": "US",
            "telephone_number": "970-764-3845",
            "fax_number": "970-764-3823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURSON",
        "first_name": "MARK",
        "middle_name": "LLOYD",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "VA",
            "license": "0101265824",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "CDR.0004667",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TN",
            "license": "40439",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "36112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4116328",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.