Healthcare Provider Details

I. General information

NPI: 1295690667
Provider Name (Legal Business Name): ASHLEY BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 RIVERSTONE TER STE 103
CANTON GA
30114-1705
US

IV. Provider business mailing address

3771 COURSON ST
MARIETTA GA
30066-8530
US

V. Phone/Fax

Practice location:
  • Phone: 770-479-1985
  • Fax:
Mailing address:
  • Phone: 205-826-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberGAA-NP004254
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: