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Individual

DR. ROGER GRADY BURRUS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
123 FAIRWAYS DR, HENDERSONVILLE, TN 37075-2610
(615) 969-2131
Mailing address
323 STEAM PLANT RD, GALLATIN, TN 37066-3025
(615) 452-1060
(615) 452-5474

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20833
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3074639
TN
Enumeration date
09/12/2005
Last updated
10/30/2015
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