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Danny Ray Burgess

Psychologist

Behavioral Health & Social Service Providers

1350 E Woodrow Wilson Ave, Jackson, MS 39216-5112

PECOS Enrollment

This provider is enrolled in PECOS as DANNY BURGESS.

Based on the most recent information from CMS, provider Danny Ray Burgess is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1346563137
Provider Type
Individual
Full Name
Burgess, Danny Ray
Title
Dr.
Credential
PHD

Gender
Male
Sole Proprietor
Yes
Enumeration Date
3/8/2010
Last Updated
8/8/2016

Contact Information

Practice Location

1350 E Woodrow Wilson Ave, Jackson, MS 39216-5112

(601) 981-2611

Unlisted Fax

Mailing Location

1910 Lakeland Dr, Suite C, Jackson, MS 39216-5029

(601) 713-1550

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 103TC0700X Primary	Description Psychologist Behavioral Health & Social Service Providers	License 49854 Mississippi

Provider Identifiers

ID	Description	Issuer
ID 06359856	Description Medicaid	Issuer Unlisted Mississippi

Danny Ray Burgess

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Schumacher-Coffey, Julie A

Smith, Patrick O

Patel, Amee B

Connolly, Kevin Mark

Greening, Leilani Lani

Karlson, Cynthia Windham

Seifen, Tanja

Lyons, Judith

Gratz, Kim L.

Lott, William C