Provider Demographics
NPI:1033476114
Name:BURRIS, ASHLEY C (NP)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:C
Last Name:BURRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:JEAN
Other - Last Name:CORNELISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 935329
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5329
Mailing Address - Country:US
Mailing Address - Phone:404-303-3617
Mailing Address - Fax:
Practice Address - Street 1:595 HURRICANE SHOALS RD NW STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8762
Practice Address - Country:US
Practice Address - Phone:404-645-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN1988894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily