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NPI Code Detail

MEDICARE: RENITA BURROWS

MEDICARE:   RENITA  BURROWS
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
1224P00000XProsthetistGA

General Provider Information

NPI Number : 1063171320
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENITA BURROWS
Provider Business Mailing Address
First Line : 1880 BRASELTON HWY STE 118-5209
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30043-2852
Country : US
Telephone Number : 678-590-9530
Fax Number :
Provider Business Practice Location Address
First Line : 1880 BRASELTON HWY STE 118-5209
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30043-2852
Country : US
Telephone Number : 678-590-9530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2021
Last Update Date : 12/14/2021

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Directions to “ RENITA BURROWS ” Practice Location

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