# JERRY BURTON BANKS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1578552410
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101232005 | VA | — |
| 207Q00000X | Family Medicine Physician | 37612 | SC | Yes |
| 207Q00000X | Family Medicine Physician | MD34440 | TN | — |

## Other

- **Enumeration date:** 10/13/2005
- **Last updated:** 02/10/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 037612200 | — | SC |
| 05 | — | 1505595 | — | TN |
| 05 | — | 1578552410 | — | VA |