Individual
LAFAYETTE BURKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
865 S 1ST ST, JESUP, GA 31545
(904) 805-1300
(904) 805-1302
Mailing address
PO BOX 532855, ATLANTA, GA 30353-2855
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
50502
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
945875
BCBS
GA
01
—
P00270549
RAILROAD MEDICARE
—
Enumeration date
10/05/2006
Last updated
01/17/2008
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