Healthcare Provider Details

I. General information

NPI: 1619802204
Provider Name (Legal Business Name): AVA E BURSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6670 PERIMETER DR STE 260
DUBLIN OH
43016-8065
US

IV. Provider business mailing address

6670 PERIMETER DR STE 260
DUBLIN OH
43016-8065
US

V. Phone/Fax

Practice location:
  • Phone: 614-389-2200
  • Fax: 614-389-3220
Mailing address:
  • Phone: 614-389-2200
  • Fax: 614-389-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010348RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: