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General NPI Number Information
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NPI Number | 1811431117
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Entity Type | Organization
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Legal Business Name | JAMES G. BURSON, MD, LLC
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 225 MILLARD FARMER IND BLVD BLDG B200
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City | NEWNAN
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State | GA
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Zip | 30263-3168
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Country | US
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Telephone | 770-955-0272
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Fax | 770-955-0273
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Provider Business Mailing Address
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Address Line | 225 MILLARD FARMER IND BLVD BLDG B200
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City | NEWNAN
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State | GA
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Zip | 30263-3168
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Country | US
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Telephone | 770-955-0272
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Fax | 770-955-0273
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Authorized Official
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Title or Position | PRACTICING OWNER
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Name | DR. JAMES G. BURSON
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Credential | MD
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Telephone | 770-955-0272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 034785
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License Number State | GA
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