Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 61702 | TN |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 61702 | TN |
NPI | 1255779948 |
---|---|
Provider Name | John Burleson |
First Address | Fortson, GA 31808-0370 |
Second Address | Nashville, TN 37211-3980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2013 |
Last Update Date | 01/10/2020 |