Provider Demographics
NPI:1487687331
Name:BURTON, KELVIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:B
Last Name:BURTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 FAIRBURN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1062
Mailing Address - Country:US
Mailing Address - Phone:770-942-1044
Mailing Address - Fax:770-942-1699
Practice Address - Street 1:2022 FAIRBURN RD
Practice Address - Street 2:SUITE D
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1062
Practice Address - Country:US
Practice Address - Phone:770-942-1044
Practice Address - Fax:770-942-1699
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032101208VP0000X, 207Q00000X
GA65394208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48117Medicare UPIN