Provider Demographics
NPI:1134110349
Name:BURROW, R ASHLEY (CSA)
Entity Type:Individual
Prefix:MR
First Name:R
Middle Name:ASHLEY
Last Name:BURROW
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 WINDING ROSE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3074
Mailing Address - Country:US
Mailing Address - Phone:770-369-6646
Mailing Address - Fax:
Practice Address - Street 1:4955 WINDING ROSE DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3074
Practice Address - Country:US
Practice Address - Phone:770-369-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
GA1264246ZS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0400XSpecialist/Technologist, OtherSurgical
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYSA193OtherKENTUCKY BOARD OF MEDICAL LICENSURE
GA1264OtherNSAA