=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972585065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY A TILGHMAN-BURCH MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2005
-----------------------------------------------------
Last Update Date | 03/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1135 BROADWAY ST
-----------------------------------------------------
City | SOUTH FULTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38257-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-479-2606
-----------------------------------------------------
Fax | 731-479-2610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1804 HIGHWAY 45 BYP STE 604
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38305-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-660-7971
-----------------------------------------------------
Fax | 731-660-8739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 37882
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------