Burgess, Sally Elaine

Burgess, Sally Elaine is an individual health care provider with primary practice located at 996 Medical Ridge Rd , Clinton SC 29325-4541. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Burgess, Sally Elaine can be contacted via phone (864) 833-5654.

Contact Information

Primary practice address
996 Medical Ridge Rd Clinton SC 29325-4541
Phone: (864) 833-5654
Fax: (864) 833-2786
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 22952 South Carolina

Profile Details

NPI number 1194879452
LBN Legal business name Burgess, Sally Elaine
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2007
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194879452 NPPES
South Carolina MEDICAID 229522
South Carolina MEDICAID RHC152
South Carolina MEDICAID GP1856
South Carolina Other 1083652630

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