Provider Demographics
NPI:1427122597
Name:BURT, VICTORIA M (NP)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:M
Last Name:BURT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31258
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-3058
Mailing Address - Country:US
Mailing Address - Phone:706-828-2374
Mailing Address - Fax:706-828-2389
Practice Address - Street 1:2258 WRIGHTSBORO RD STE 400
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4788
Practice Address - Country:US
Practice Address - Phone:706-724-4400
Practice Address - Fax:706-724-6003
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily