Provider Demographics
NPI:1578800389
Name:BURCKHALTER, LINDSAY WILLIAMS
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:WILLIAMS
Last Name:BURCKHALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 HIGHWAY 124 W
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-5534
Mailing Address - Country:US
Mailing Address - Phone:706-654-5775
Mailing Address - Fax:706-654-9132
Practice Address - Street 1:6055 HIGHWAY 124 W
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-5534
Practice Address - Country:US
Practice Address - Phone:706-654-5775
Practice Address - Fax:706-654-9132
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist