Provider Demographics
NPI:1407181563
Name:BURNS, COLUMBUS BENJAMIN III (DMIN)
Entity Type:Individual
Prefix:
First Name:COLUMBUS
Middle Name:BENJAMIN
Last Name:BURNS
Suffix:III
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST 63RD STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4226
Mailing Address - Country:US
Mailing Address - Phone:912-660-4678
Mailing Address - Fax:912-691-9007
Practice Address - Street 1:201 EAST 63RD STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4226
Practice Address - Country:US
Practice Address - Phone:912-660-4678
Practice Address - Fax:912-691-9007
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004393101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor