Individual
JOHN C BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1340
(864) 512-1749
Mailing address
800 NORTH FANT STREET, ANDERSON, SC 29621-5708
(864) 512-1417
(864) 512-3719
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
088669
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
476529
UNISON
SC
05
—
AN2174
—
SC
01
—
NPI # / SSN#
BLUE CHOICE
SC
Enumeration date
12/09/2011
Last updated
03/13/2012
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