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General NPI Number Information
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NPI Number | 1508169426
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Entity Type | Organization
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Legal Business Name | BURTON MEDICAL GROUP LLC
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 210 MERCER JCT
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City | MACON
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State | GA
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Zip | 31210-4016
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Country | US
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Telephone | 478-471-8593
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Fax | 478-471-8599
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Provider Business Mailing Address
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Address Line | 210 MERCER JCT
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City | MACON
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State | GA
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Zip | 31210-4016
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Country | US
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Telephone | 478-471-8593
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Fax | 478-471-8599
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LISA SANFORD
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Credential |
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Telephone | 478-471-8593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 061948
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 002499
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 038434
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License Number State | GA
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