Healthcare Provider Details

I. General information

NPI: 1427122597
Provider Name (Legal Business Name): VICTORIA M BURT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 WRIGHTSBORO RD STE 400
AUGUSTA GA
30904-4788
US

IV. Provider business mailing address

PO BOX 31258
AUGUSTA GA
30903-3058
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-4400
  • Fax: 706-724-6003
Mailing address:
  • Phone: 706-828-2374
  • Fax: 706-828-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN093515
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: