Basic Information
| Provider Information | |||||||||
| NPI: | 1518351337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALLY W. BURBANK, M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1916 PATTERSON ST | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153404460 | ||||||||
| FaxNumber: | 6153404481 | ||||||||
| Practice Location | |||||||||
| Address1: | 1916 PATTERSON STREET | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153404460 | ||||||||
| FaxNumber: | 6153404481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2015 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | BURBANK | ||||||||
| AuthorizedOfficialFirstName: | SALLY | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6153404460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0094089 | 01 | TN | BCBS | OTHER |