Healthcare Provider Details

I. General information

NPI: 1194046771
Provider Name (Legal Business Name): TOTAL CARE FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 FAIRBURN RD SUITE D
DOUGLASVILLE GA
30135-1062
US

IV. Provider business mailing address

2022 FAIRBURN RD SUITE D
DOUGLASVILLE GA
30135-1062
US

V. Phone/Fax

Practice location:
  • Phone: 770-942-1044
  • Fax: 770-942-1699
Mailing address:
  • Phone: 770-942-1044
  • Fax: 770-942-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KELVIN BERTRAM BURTON
Title or Position: CEO
Credential: M.D.
Phone: 770-942-1044