Provider Demographics
NPI:1962120196
Name:BURROUGHS, JUDITH ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:RIEGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:556 CIFFORD MEEKS RD
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:GA
Mailing Address - Zip Code:30421
Mailing Address - Country:US
Mailing Address - Phone:912-536-5534
Mailing Address - Fax:
Practice Address - Street 1:556 CIFFORD MEEKS RD
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:GA
Practice Address - Zip Code:30421
Practice Address - Country:US
Practice Address - Phone:912-536-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197836363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health