Provider Demographics
NPI:1952037491
Name:BURGIO, COLLEEN A
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:BURGIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2763 MEADOW CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4989
Mailing Address - Country:US
Mailing Address - Phone:770-508-0719
Mailing Address - Fax:888-838-0381
Practice Address - Street 1:203 PORT ROYAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-3006
Practice Address - Country:US
Practice Address - Phone:912-665-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142200163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management