Burrus, Roger Grady

Burrus, Roger Grady is an sole proprietor health care provider with primary practice located at 123 Fairways Dr , Hendersonville TN 37075-2610. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Burrus, Roger Grady can be contacted via phone (615) 969-2131.

Contact Information

Primary practice address
123 Fairways Dr Hendersonville TN 37075-2610
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 20833 Tennessee

Profile Details

NPI number 1114912656
LBN Legal business name Burrus, Roger Grady
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 12th, 2005
Last updated Oct 30th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114912656 NPPES
Tennessee MEDICAID 3074639

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