Individual
MR. COREY A BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3236 HWY 15 S, SUMTER, SC 29150-9657
(803) 506-2005
Mailing address
1775 BRIGATINE DR, SUMTER, SC 29154-7377
(803) 406-4886
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
341600000X
Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063646610
NPPES
SC
Enumeration date
05/12/2009
Last updated
02/19/2016
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