Doctor Name: | MATT JAMES BURCH |
NPI Number: | 1972987899 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 005247 |
Business Practice Address: | 4073 Highway 53 Hoschton, GA - 305482305 |
Business Phone Number: | 7708825884 |
Business Fax Number: | 7066580116 |
Mailing Address: | 4073 Highway 53, HOSCHTON |
State: | GA |
Postal Code: | 305482305 |
Phone Number: | 7708825884 |
Fax Number: | 7066580116 |
NPI Enumeration Date: | 07/10/2015 |
NPI Last Update Date: | 07/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 005247 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |