MEDICARE: ERICK BOURNIGAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	33280	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110181970	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275548547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICK BOURNIGAL MD

Provider Business Mailing Address
First Line	:	3025 SHRINE RD
Second Line	:	SUITE 280
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4784
Country	:	US
Telephone Number	:	912-466-7311
Fax Number	:	912-466-7313

Provider Business Practice Location Address
First Line	:	1111 GLYNCO PARKWAY
Second Line	:	SUITE 30
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-7930
Country	:	US
Telephone Number	:	912-267-1026
Fax Number	:	912-265-5415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	03/07/2023

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Directions to “ ERICK BOURNIGAL MD” Practice Location

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