Healthcare Provider Details

I. General information

NPI: 1568449486
Provider Name (Legal Business Name): ASHBY JEFFRIES BURTON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: A. JEFF BURTON III MD

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 THREE CHOPT RD
LITTLETON NC
27850-8071
US

IV. Provider business mailing address

129 THREE CHOPT RD
LITTLETON NC
27850-8071
US

V. Phone/Fax

Practice location:
  • Phone: 252-586-2105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28738
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: