Organization
GASTON FAMILY MEDICINE, P. A.
Active
Other names
Kenneth D. Burgess, M. D.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH DAVID BURGESS M. D. (OWNER/ PRESIDENT)
(704) 824-9119
Entity
Organization
Contact information
Practice address
3845 SOUTH NEW HOPE ROAD, GASTONIA, NC 28056-8439
(704) 824-9119
(704) 824-2401
Mailing address
PO BOX 551178, GASTONIA, NC 28055-1178
(704) 824-9119
(704) 824-2401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32655
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19982
BCBS
NC
05
—
8919982
—
NC
01
—
P00297412
PALMETTO GBA
NC
Enumeration date
02/22/2008
Last updated
07/14/2008
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