Provider Demographics
NPI:1275548547
Name:BOURNIGAL, ERICK (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:BOURNIGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3025 SHRINE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4784
Mailing Address - Country:US
Mailing Address - Phone:912-466-7311
Mailing Address - Fax:912-466-7313
Practice Address - Street 1:1111 GLYNCO PARKWAY
Practice Address - Street 2:SUITE 30
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7930
Practice Address - Country:US
Practice Address - Phone:912-267-1026
Practice Address - Fax:912-265-5415
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA33280207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00435773BMedicaid
GA110181970OtherRR MEDICARE
GA110181970OtherRR MEDICARE
GA110181970OtherRR MEDICARE
GA11BDPSKMedicare ID - Type Unspecified