Individual
SHAWN T BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
501 S SHARON AMITY RD STE 300, CHARLOTTE, NC 28211-0035
(704) 377-2424
(704) 377-2687
Mailing address
501 S SHARON AMITY RD STE 300, CHARLOTTE, NC 28211-0035
(704) 377-2424
(704) 377-2687
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2007-00097
NC
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
52338
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145G7
BCBS
NC
05
—
5907523
—
NC
01
—
N00091
MEDICAID
SC
Enumeration date
07/14/2006
Last updated
11/28/2018
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