MEDICARE: BROOKE LYNN BURTON

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	251J00000X	Nursing Care Agency	19071050	GA

General Provider Information

NPI Number	:	1710545975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE LYNN BURTON

Provider Business Mailing Address
First Line	:	602 WALTON WAY SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-3856
Country	:	US
Telephone Number	:	770-870-9799
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 WALTON WAY SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-3856
Country	:	US
Telephone Number	:	770-870-9799
Fax Number	:

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

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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