Provider Demographics
NPI:1124433768
Name:TOTAL CARE FAMILY MEDICINE PC
Entity type:Organization
Organization Name:TOTAL CARE FAMILY MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-942-1044
Mailing Address - Street 1:2022 FAIRBURN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:770-942-1699
Practice Address - Street 1:305 CARROLLTON ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:GA
Practice Address - Zip Code:30179-3796
Practice Address - Country:US
Practice Address - Phone:770-942-1044
Practice Address - Fax:770-942-1699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL CARE FAMILY MEDICINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-23
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty