Provider Demographics
NPI:1922583525
Name:BURGESS, ELIZABETH (ARNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 JOHNSON FERRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1618
Mailing Address - Country:US
Mailing Address - Phone:404-785-7792
Mailing Address - Fax:
Practice Address - Street 1:975 JOHNSON FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1618
Practice Address - Country:US
Practice Address - Phone:404-785-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN316006363LP0200X
FLAPRN9368953363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics