Healthcare Provider Details

I. General information

NPI: 1952037491
Provider Name (Legal Business Name): COLLEEN A BURGIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 PORT ROYAL DR
SAVANNAH GA
31410-3006
US

IV. Provider business mailing address

2763 MEADOW CHURCH RD
DULUTH GA
30097-4989
US

V. Phone/Fax

Practice location:
  • Phone: 912-665-8756
  • Fax:
Mailing address:
  • Phone: 770-508-0719
  • Fax: 888-838-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN142200
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: