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General NPI Number Information
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NPI Number | 1275548547
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Entity Type | Individual
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Provider Name | ERICK BOURNIGAL MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1111 GLYNCO PARKWAY SUITE 30
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City | BRUNSWICK
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State | GA
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Zip | 31525-7930
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Country | US
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Telephone | 912-267-1026
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Fax | 912-265-5415
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Provider Business Mailing Address
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Address Line | 3025 SHRINE RD SUITE 280
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City | BRUNSWICK
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State | GA
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Zip | 31520-4784
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Country | US
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Telephone | 912-466-7311
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Fax | 912-466-7313
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 33280
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License Number State | GA
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