Basic Information
| Provider Information | |||||||||
| NPI: | 1659809846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | KEVIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1061 HARMON AVE | ||||||||
| Address2: | |||||||||
| City: | FORT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313145641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124356965 | ||||||||
| FaxNumber: | 7067871745 | ||||||||
| Practice Location | |||||||||
| Address1: | 1061 HARMON AVE | ||||||||
| Address2: | |||||||||
| City: | FORT STEWART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313145641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124356965 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2017 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 82639 | GA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | GA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 82639 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.