Provider Demographics
NPI:1578558805
Name:BURTON, NORRIS KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:NORRIS
Middle Name:KENT
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 1:907 18TH ST E STE 140
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3643
Mailing Address - Country:US
Mailing Address - Phone:229-353-4325
Mailing Address - Fax:
Practice Address - Street 1:907 18TH ST E
Practice Address - Street 2:SUITE 140
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3643
Practice Address - Country:US
Practice Address - Phone:229-353-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52576054 002OtherBCBS OF GA PIN
GA000398593EMedicaid
GA52576054 002OtherGA DEPT. OF COMMUNITY HEA
GA010031078OtherRAILROAD MEDICARE PIN
GA900158275OtherTRICARE PIN
GA900158275OtherTRICARE PIN
GAE16140Medicare UPIN