Healthcare Provider Details

I. General information

NPI: 1992791727
Provider Name (Legal Business Name): MARILYN ANN BURSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 LEIGHTON AVE
ANNISTON AL
36207-5761
US

IV. Provider business mailing address

PO BOX 2391
ANNISTON AL
36202-2391
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-5688
  • Fax: 256-235-5590
Mailing address:
  • Phone: 256-235-5688
  • Fax: 286-235-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number11334
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: