MEDICARE: ANTWAUN BURROUGHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	775	AL

General Provider Information

NPI Number	:	1265930812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTWAUN BURROUGHS

Provider Business Mailing Address
First Line	:	181 W VALLEY AVE STE 225
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-3691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 W VALLEY AVE STE 225
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-3691
Country	:	US
Telephone Number	:	205-919-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	04/26/2018

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Directions to “ ANTWAUN BURROUGHS ” Practice Location

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