Provider Demographics
NPI:1902679749
Name:BURGESS, JAMAL LIONEL (MA)
Entity type:Individual
Prefix:MR
First Name:JAMAL
Middle Name:LIONEL
Last Name:BURGESS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 RALEIGH DR APT 31
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2077
Mailing Address - Country:US
Mailing Address - Phone:843-373-9993
Mailing Address - Fax:
Practice Address - Street 1:801 N PIKE W
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-1906
Practice Address - Country:US
Practice Address - Phone:843-934-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor