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General NPI Number Information
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NPI Number | 1497094106
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Entity Type | Organization
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Legal Business Name | N KENT BURTON MEDICAL DIRECTOR
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 2401 RIDGE AVE N
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City | TIFTON
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State | GA
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Zip | 31794-2846
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Country | US
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Telephone | 229-392-8520
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Fax | 229-391-3578
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Provider Business Mailing Address
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Address Line | 2401 RIDGE AVENUE NORTH
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | NORRIS K BURTON
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Credential |
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Telephone | 229-392-8520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 031888
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License Number State | GA
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