MEDICARE: ELIZABETH BURGESS ARNP

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	363LP0200X	Pediatric Nurse Practitioner	RN316006	GA

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	:	1922583525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BURGESS ARNP

Provider Business Mailing Address
First Line	:	975 JOHNSON FERRY RD STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1618
Country	:	US
Telephone Number	:	404-785-7792
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 JOHNSON FERRY RD STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1618
Country	:	US
Telephone Number	:	404-785-7792
Fax Number	:

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

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	12/03/2024

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