Healthcare Provider Details

I. General information

NPI: 1811982036
Provider Name (Legal Business Name): WALTER MCARTHUR BURT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 REDMOND RD NW
ROME GA
30165-1538
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 706-234-8221
  • Fax: 706-291-9647
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR006696
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: