Active NPI
Matthew O Burrell, M.D.
- Gynecologic Oncology Physician
- Lawrenceville, GA
National Provider Identifier
1780650283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecologic Oncology Physician
- License
- 017998
- Practice address
- 759 Old Norcross Rd
Lawrenceville, GA 30046-4317 - Phone
- (404) 300-2379
- Fax
- (404) 300-2379
- NPI assigned
- Feb 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecologic Oncology Physician | 207VX0201X | 017998 | GA | Primary |
Addresses
Primary practice location
759 Old Norcross Rd
Lawrenceville, GA 30046-4317
Mailing address
759 Old Norcross Rd
Lawrenceville, GA 30046-4317
Phone (404) 300-2379
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000086589H | Medicaid | GA | |
| 000086589F | Medicaid | GA | |
| 000086589G | Medicaid | GA | |
| 00086589B | Medicaid | GA | |
| 0702361 | Other | GA | UHC |
| 025915 | Other | GA | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017998 | GA | MD | Gynecologic Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485907200000",
"number": "1780650283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "759 OLD NORCROSS RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300464317",
"telephone_number": "404-300-2379",
"fax_number": "404-300-2379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "759 OLD NORCROSS RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300464317",
"telephone_number": "404-300-2379",
"fax_number": "404-300-2379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURRELL",
"first_name": "MATTHEW",
"middle_name": "O",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-24",
"last_updated": "2017-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "207VX0201X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecologic Oncology",
"state": "GA",
"license": "017998",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000086589H",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000086589F",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000086589G",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00086589B",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "0702361",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "025915",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.