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General NPI Number Information
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NPI Number | 1376286815
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Entity Type | Individual
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Provider Name | GREGORY BURTON
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Gender | Male
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1509 ARCADE AVE APT 1
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City | LOUISVILLE
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State | KY
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Zip | 40215-2125
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Country | US
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Telephone | 502-443-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 ARCADE AVE APT 1
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City | LOUISVILLE
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State | KY
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Zip | 40215-2125
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Country | US
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Telephone | 502-443-3998
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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