Healthcare Provider Details

I. General information

NPI: 1619971686
Provider Name (Legal Business Name): DEBORAH M. BURTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 WINDY HILL RD SE STE 307
MARIETTA GA
30067-8665
US

IV. Provider business mailing address

2550 WINDY HILL RD SE STE 307
MARIETTA GA
30067-8665
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-1414
  • Fax: 770-953-9474
Mailing address:
  • Phone: 770-953-1414
  • Fax: 770-953-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number039297
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number039297
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: