Provider Demographics
NPI:1336246149
Name:BURGETT, AMY CORA (MDFACOG)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CORA
Last Name:BURGETT
Suffix:
Gender:F
Credentials:MDFACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WYNDHAM CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3856
Mailing Address - Country:US
Mailing Address - Phone:912-355-8136
Mailing Address - Fax:
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-355-8136
Practice Address - Fax:912-352-7014
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030022174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00598001CMedicaid
GA00598001CMedicaid