Provider Demographics
NPI:1396405825
Name:BURROUGHS, LORNE KEITH
Entity Type:Individual
Prefix:MR
First Name:LORNE
Middle Name:KEITH
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 ABERCORN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5526
Mailing Address - Country:US
Mailing Address - Phone:912-352-0448
Mailing Address - Fax:912-352-0450
Practice Address - Street 1:6203 ABERCORN ST STE 12
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5526
Practice Address - Country:US
Practice Address - Phone:912-352-0448
Practice Address - Fax:912-352-0450
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-24
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA538132225000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter