1811431117 NPI number — JAMES G. BURSON, MD, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811431117 NPI number — JAMES G. BURSON, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES G. BURSON, MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1811431117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 MILLARD FARMER IND BLVD
Provider Second Line Business Mailing Address:
BLDG B200
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30263-3168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-955-0272
Provider Business Mailing Address Fax Number:
770-955-0273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 MILLARD FARMER IND BLVD
Provider Second Line Business Practice Location Address:
BLDG B200
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30263-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-955-0272
Provider Business Practice Location Address Fax Number:
770-955-0273
Provider Enumeration Date:
12/06/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BURSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRACTICING OWNER
Authorized Official Telephone Number:
770-955-0272

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  034785 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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