MEDICARE: ASHLEY BURTON

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
1	363LP0200X	Pediatric Nurse Practitioner	GAA-NP004254	GA

General Provider Information

NPI Number	:	1295690667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BURTON

Provider Business Mailing Address
First Line	:	3771 COURSON ST
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-8530
Country	:	US
Telephone Number	:	205-826-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 RIVERSTONE TER STE 103
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-1705
Country	:	US
Telephone Number	:	770-479-1985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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Directions to “ ASHLEY BURTON ” Practice Location

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