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General NPI Number Information
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NPI Number | 1104830264
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Entity Type | Individual
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Provider Name | GEORGE LEWIS BURRUSS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 80 HUMPHREYS CTR STE 100
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City | MEMPHIS
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State | TN
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Zip | 38120-2352
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Country | US
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Telephone | 901-761-9030
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Fax | 901-473-6505
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Provider Business Mailing Address
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Address Line | 80 HUMPHREYS CTR STE 100
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City | MEMPHIS
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State | TN
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Zip | 38120-2352
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Country | US
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Telephone | 901-761-9030
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Fax | 901-473-6505
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 10817
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License Number State | TN
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