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NPI Code Detail

MEDICARE: LUCIA GOODWIN BURGESS MD

MEDICARE: LUCIA GOODWIN BURGESS 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
1207R00000XInternal Medicine Physician2021036601MO
2207R00000XInternal Medicine Physician2025-02712NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12021036601OTHERMOSTATE LICENSE NUMBER

General Provider Information

NPI Number : 1336709401
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCIA GOODWIN BURGESS MD
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1942 E 7TH ST STE 200
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2557
Country : US
Telephone Number : 704-384-7085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2019
Last Update Date : 09/30/2025

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Directions to “ LUCIA GOODWIN BURGESS MD” Practice Location

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