Provider Demographics
NPI:1801061452
Name:BURGETT, JUSTIN PRICE (FNP-BC, RN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PRICE
Last Name:BURGETT
Suffix:
Gender:M
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2597
Mailing Address - Country:US
Mailing Address - Phone:706-278-0138
Mailing Address - Fax:
Practice Address - Street 1:1114 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2597
Practice Address - Country:US
Practice Address - Phone:706-278-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233030363LF0000X, 163W00000X
TN163538163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse