Provider Demographics
NPI:1891253761
Name:BURTON, SAMANTHA BRETT (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BRETT
Last Name:BURTON
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WALNUT ST UNIT 109
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1143
Mailing Address - Country:US
Mailing Address - Phone:931-434-2205
Mailing Address - Fax:
Practice Address - Street 1:620 E 11TH ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3101
Practice Address - Country:US
Practice Address - Phone:423-643-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered