Provider Demographics
NPI:1437702602
Name:BURCH, MARY MARGARET (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:BURCH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:BEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 DRESDEN DR NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3579
Mailing Address - Country:US
Mailing Address - Phone:404-814-9808
Mailing Address - Fax:
Practice Address - Street 1:1401 DRESDEN DR NE STE 200
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3579
Practice Address - Country:US
Practice Address - Phone:404-814-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN234310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine