Healthcare Provider Details

I. General information

NPI: 1306788849
Provider Name (Legal Business Name): ELIZABETH ROSE BURGESS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 LANEY WALKER BLVD
AUGUSTA GA
30912-0002
US

IV. Provider business mailing address

680 CRANE CREEK DR APT 132
AUGUSTA GA
30907-3076
US

V. Phone/Fax

Practice location:
  • Phone: 762-375-2541
  • Fax:
Mailing address:
  • Phone: 678-458-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number112165
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: