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General NPI Number Information
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NPI Number | 1083706378
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Entity Type | Individual
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Provider Name | STEVEN G BURDETTE ATC
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 GROSS CRESCENT CIR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3643
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Country | US
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Telephone | 706-858-2946
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Fax |
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Provider Business Mailing Address
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Address Line | 649 EAGLE VIEW DR
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City | RINGGOLD
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State | GA
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Zip | 30736-7093
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Country | US
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Telephone | 423-505-2709
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000442AT
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License Number State | GA
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