Healthcare Provider Details

I. General information

NPI: 1972569853
Provider Name (Legal Business Name): ELIZABETH M BURNS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH M LOSKEN MD

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 PEACHTREE DUNWOODY RD STE 412
ATLANTA GA
30342-1758
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 404-459-9177
  • Fax: 404-389-0400
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number052465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: