Healthcare Provider Details

I. General information

NPI: 1649534314
Provider Name (Legal Business Name): JULYN KENDRA BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY STE 5700
AUGUSTA GA
30901-5110
US

IV. Provider business mailing address

1348 WALTON WAY STE 5700
AUGUSTA GA
30901-5110
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-7022
  • Fax: 706-774-7023
Mailing address:
  • Phone: 706-774-7022
  • Fax: 706-774-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN162227
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN162227
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: