Basic Information
| Provider Information | |||||||||
| NPI: | 1659472744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | BRUGGEMAR | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5356 REYNOLDS ST | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123033560 | ||||||||
| FaxNumber: | 9123033506 | ||||||||
| Practice Location | |||||||||
| Address1: | 5356 REYNOLDS ST | ||||||||
| Address2: | SUITE 505 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123033560 | ||||||||
| FaxNumber: | 9123033506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 04/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AUD003419 | GA | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 000831652N | 05 | GA | MEDICAID |