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NPI Code Detail

MEDICARE: MRS. DESHELLE RESHUN BURROWES APC

MEDICARE: MRS. DESHELLE RESHUN BURROWES APC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorAPC006176GA

General Provider Information

NPI Number : 1871075614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DESHELLE RESHUN BURROWES APC
Provider Business Mailing Address
First Line : 123 E ATLANTA RD STE B200
Second Line :
City : STOCKBRIDGE
State : GA
Zip : 30281-3448
Country : US
Telephone Number : 770-871-1712
Fax Number :
Provider Business Practice Location Address
First Line : 320 LANIER AVE W STE 200
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-7443
Country : US
Telephone Number : 770-871-1712
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 04/29/2020

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