Provider Demographics
NPI:1518351337
Name:SALLY W. BURBANK, M.D.
Entity Type:Organization
Organization Name:SALLY W. BURBANK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURBANK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-340-4460
Mailing Address - Street 1:1916 PATTERSON ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2120
Mailing Address - Country:US
Mailing Address - Phone:615-340-4460
Mailing Address - Fax:615-340-4481
Practice Address - Street 1:1916 PATTERSON STREET
Practice Address - Street 2:SUITE 503
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2021
Practice Address - Country:US
Practice Address - Phone:615-340-4460
Practice Address - Fax:615-340-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0094089OtherBCBS
TND93200Medicare UPIN
TN0094089OtherBCBS