Healthcare Provider Details

I. General information

NPI: 1437640935
Provider Name (Legal Business Name): PAUL BUURMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 DREW RD
CUMMING GA
30040-9441
US

IV. Provider business mailing address

2420 ROSE WALK DR
ALPHARETTA GA
30005-8331
US

V. Phone/Fax

Practice location:
  • Phone: 770-888-3470
  • Fax:
Mailing address:
  • Phone: 678-799-6279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: