Provider Demographics
NPI:1265465959
Name:BURBANK, SALLY W (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:W
Last Name:BURBANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:1916 PATTERSON ST STE 503
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2117
Practice Address - Country:US
Practice Address - Phone:615-340-4460
Practice Address - Fax:615-340-4481
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN018266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND93200Medicare UPIN
TN3043848Medicare ID - Type Unspecified