Individual
JUSTIN BRYCE BURGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-3606
(601) 579-5383
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-3606
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
3007275
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
A810475
MS
390200000X
Student in an Organized Health Care Education/Training Program
R877664
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01235096
—
MS
01
—
3539043
UNITED HEALTHCARE
MS
01
—
8318378
CIGNA
MS
01
—
9758895
AETNA
MS
Enumeration date
10/17/2011
Last updated
08/23/2016
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