Healthcare Provider Details

I. General information

NPI: 1093746638
Provider Name (Legal Business Name): BURTON WILLIAM STEVENS JR. DPT, SCS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6884 HICKORY FLAT HWY
WOODSTOCK GA
30188-3229
US

IV. Provider business mailing address

6884 HICKORY FLAT HWY
WOODSTOCK GA
30188-3229
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-8244
  • Fax: 770-704-8264
Mailing address:
  • Phone: 770-704-8244
  • Fax: 770-704-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17884
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: