Provider Demographics
NPI:1083661433
Name:BURNS, ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 ASHLEY CROSSING DR
Mailing Address - Street 2:STE 170
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414
Mailing Address - Country:US
Mailing Address - Phone:843-763-3700
Mailing Address - Fax:843-763-3714
Practice Address - Street 1:2270 ASHLEY CROSSING DR
Practice Address - Street 2:STE 170
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-763-3700
Practice Address - Fax:843-763-3714
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR00031684207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571020809011OtherTRICARE SC
SC571020809006OtherBCBS SC
SCNP0755Medicaid
SC571020809011OtherTRICARE SC
SC571020809006OtherBCBS SC