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NPI Code Detail

MEDICARE: FANNY BURDINE

MEDICARE: FANNY BURDINE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerP012303NC

General Provider Information

NPI Number : 1871078329
Entity Type Code : Individual
Provider Name (Legal Business Name) : FANNY BURDINE
Provider Business Mailing Address
First Line : 6931 SAVANNAH SPRINGS DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-1638
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6931 SAVANNAH SPRINGS DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-1638
Country : US
Telephone Number : 267-353-5026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2018
Last Update Date : 10/01/2018

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Directions to “ FANNY BURDINE ” Practice Location

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