Healthcare Provider Details

I. General information

NPI: 1023646064
Provider Name (Legal Business Name): BRANDON WILLIAM BURROWAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 PLEASANT HILL RD
DULUTH GA
30096-4807
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 770-814-8222
  • Fax: 678-205-5111
Mailing address:
  • Phone: 770-814-8222
  • Fax: 678-205-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number104339
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number104339
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: