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General NPI Number Information
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NPI Number | 1669876066
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Entity Type | Individual
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Provider Name | KEVIN BURCH SR.
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Gender | Male
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-321-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 6103 MAGNOLIA POINTE BLVD
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City | DULUTH
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State | GA
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Zip | 30096-9059
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Country | US
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Telephone | 386-898-3942
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 0014190811
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License Number State | GA
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