Healthcare Provider Details

I. General information

NPI: 1275604308
Provider Name (Legal Business Name): PERSONAL TOUCH MEDICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 NE BROAD ST
FAIRBURN GA
30213-1474
US

IV. Provider business mailing address

PO BOX 3464
FLORENCE SC
29502-3464
US

V. Phone/Fax

Practice location:
  • Phone: 678-778-5869
  • Fax:
Mailing address:
  • Phone: 678-778-5869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number049877
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATASHA BURGESS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 678-778-5869