Healthcare Provider Details

I. General information

NPI: 1538023890
Provider Name (Legal Business Name): CODY BURFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

171 LAKETREE BLVD
SPRING LAKE NC
28390-3189
US

IV. Provider business mailing address

304 WHIPPLE TREE LN
FAYETTEVILLE NC
28314-1075
US

V. Phone/Fax

Practice location:
  • Phone: 910-678-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP572069
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: