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General NPI Number Information
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NPI Number | 1851920573
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Entity Type | Individual
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Provider Name | KISHA LASHAUN BURGESS DO
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Gender | Female
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Dates
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Enumeration Date | 04/04/2020
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 720 WESTVIEW DR SW
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City | ATLANTA
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State | GA
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Zip | 30310-1458
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Country | US
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Telephone | 404-756-1368
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Fax | 404-756-1313
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Provider Business Mailing Address
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Address Line | 12470 SW 185TH ST
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City | MIAMI
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State | FL
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Zip | 33177-3186
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Country | US
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Telephone | 305-299-2508
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 97697
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License Number State | GA
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