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General NPI Number Information
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NPI Number | 1952446817
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Entity Type | Individual
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Provider Name | CHARLES H BURTON JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 1587 PHOENIX BLVD SUITE 6
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5540
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Country | US
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Telephone | 770-994-6806
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Fax | 770-994-6807
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Provider Business Mailing Address
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Address Line | 1587 PHOENIX BLVD SUITE 6
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5540
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Country | US
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Telephone | 770-994-6806
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Fax | 770-994-6807
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 023025
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License Number State | GA
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