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General NPI Number Information
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NPI Number | 1679923528
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Entity Type | Individual
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Provider Name | MAJOR BENJAMIN BURCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 81 PROMINENCE CT STE 100
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6372
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Country | US
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Telephone | 770-532-7202
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 JESSE JEWELL PKWY SE STE 300
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City | GAINESVILLE
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State | GA
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Zip | 30501-3861
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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 |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD17574
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 29894
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 29894
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 101143
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License Number State | GA
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