Individual
JACK BURTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(202) 939-2577
Mailing address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2804
SC
Other
Enumeration date
09/19/2022
Last updated
01/14/2025
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