Provider Demographics
NPI:1275826521
Name:BURGY, JESSICA R (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:R
Last Name:BURGY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LAKE MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8623
Mailing Address - Country:US
Mailing Address - Phone:803-731-9600
Mailing Address - Fax:803-731-0297
Practice Address - Street 1:1600 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8623
Practice Address - Country:US
Practice Address - Phone:803-731-9600
Practice Address - Fax:803-731-0297
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD37851207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology