1851281349 NPI number — BURTON TIMOTHY CARRIKER LPC004623

Table of content: BURTON TIMOTHY CARRIKER LPC004623 (NPI 1851281349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851281349 NPI number — BURTON TIMOTHY CARRIKER LPC004623

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRIKER
Provider First Name:
BURTON
Provider Middle Name:
TIMOTHY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC004623
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851281349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5466 DOUBLE EAGLE CIR UNIT 3425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVE MARIA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34142-5233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-316-4120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5466 DOUBLE EAGLE CIR UNIT 3425
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVE MARIA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34142-5233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-316-4120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  004623 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com