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Individual

DR. DANNY RAY BURGESS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
1350 E WOODROW WILSON AVE, JACKSON, MS 39216-5112
(601) 981-2611
Mailing address
1910 LAKELAND DR, SUITE C, JACKSON, MS 39216-5029
(601) 713-1550

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
49854
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
06359856
MS
Enumeration date
03/08/2010
Last updated
08/08/2016
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