Healthcare Provider Details

I. General information

NPI: 1396405825
Provider Name (Legal Business Name): MR. LORNE KEITH BURROUGHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2021
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 ABERCORN ST STE 12
SAVANNAH GA
31405-5526
US

IV. Provider business mailing address

6203 ABERCORN ST STE 12
SAVANNAH GA
31405-5526
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-0448
  • Fax: 912-352-0450
Mailing address:
  • Phone: 912-352-0448
  • Fax: 912-352-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number538132
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: