# GASTON FAMILY MEDICINE, P. A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kenneth D. Burgess, M. D.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992974042
- **Authorized official:** MR. KENNETH DAVID BURGESS M. D. (OWNER/ PRESIDENT)
- **Authorized official phone:** (704) 824-9119

## Contact information

- **Practice address:** 3845 SOUTH NEW HOPE ROAD, GASTONIA, NC 28056-8439
- **Practice address phone:** (704) 824-9119
- **Practice address fax:** (704) 824-2401
- **Mailing address:** PO BOX 551178, GASTONIA, NC 28055-1178
- **Mailing address phone:** (704) 824-9119
- **Mailing address fax:** (704) 824-2401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 32655 | NC | Yes |

## Other

- **Enumeration date:** 02/22/2008
- **Last updated:** 07/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 19982 | BCBS | NC |
| 05 | — | 8919982 | — | NC |
| 01 | — | P00297412 | PALMETTO GBA | NC |