Individual
GARRY WAYNE BURKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6845 S YORK HWY, CLARKRANGE, TN 38553-5154
(931) 863-5095
(931) 863-3530
Mailing address
PO BOX 2861, CROSSVILLE, TN 38557-2861
(931) 863-5095
(931) 863-3530
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA454
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3104164
BLUE CROSS BLUE SHEILD TN
TN
Enumeration date
08/09/2006
Last updated
03/25/2024
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