Healthcare Provider Details

I. General information

NPI: 1134920713
Provider Name (Legal Business Name): BURGESS ELITE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 WALL ST SE STE 240
CONYERS GA
30013-2296
US

IV. Provider business mailing address

2375 WALL ST SE STE 240
CONYERS GA
30013-2296
US

V. Phone/Fax

Practice location:
  • Phone: 770-679-1121
  • Fax: 470-741-8709
Mailing address:
  • Phone: 770-679-1121
  • Fax: 470-200-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: STINESHA FERGUSON
Title or Position: OWNER
Credential:
Phone: 404-274-3851