MEDICARE: MELISSA SUZANNE BURROUGHS MD

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	207R00000X	Internal Medicine Physician	A110255	CA
2	207RC0000X	Cardiovascular Disease Physician	A110255	CA
3	207RC0000X	Cardiovascular Disease Physician	88248	GA

General Provider Information

NPI Number	:	1437485968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SUZANNE BURROUGHS MD

Provider Business Mailing Address
First Line	:	144 BILL CARRUTH PKWY STE 4200
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3819
Country	:	US
Telephone Number	:	678-324-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 BILL CARRUTH PKWY STE 4200
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-3819
Country	:	US
Telephone Number	:	770-424-6893
Fax Number	:

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

Provider Enumeration Date	:	10/17/2009
Last Update Date	:	07/15/2021

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