Provider Demographics
NPI:1023021060
Name:BURROWES, CELIO O (MD)
Entity Type:Individual
Prefix:
First Name:CELIO
Middle Name:O
Last Name:BURROWES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:678-904-1606
Mailing Address - Fax:678-904-2522
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 515
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:678-904-1606
Practice Address - Fax:678-904-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000666289CMedicaid
GAG11644Medicare UPIN
GA02BDFHNMedicare ID - Type UnspecifiedGA MEDICARE PROVIDER ID