MEDICARE: J BARRY BURGESS

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	1223P0221X	Pediatric Dentistry	3482	AL

General Provider Information

NPI Number	:	1891972501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J BARRY BURGESS

Provider Business Mailing Address
First Line	:	1825 MCFARLAND BLVD N STE D
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-2236
Country	:	US
Telephone Number	:	205-330-0866
Fax Number	:	205-366-1099

Provider Business Practice Location Address
First Line	:	1825 MCFARLAND BLVD N STE D
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-2236
Country	:	US
Telephone Number	:	205-330-0866
Fax Number	:	205-366-1099

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. J BARRY BURGESS
Credential	:
Telephone Number	:	205-330-0866

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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