Provider Demographics
NPI:1245597525
Name:BURRIS, BRIAN D (SA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:BURRIS
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CALEDONIA RD
Mailing Address - Street 2:APT. 18
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-0900
Mailing Address - Country:US
Mailing Address - Phone:423-987-9873
Mailing Address - Fax:
Practice Address - Street 1:60 CALEDONIA RD
Practice Address - Street 2:APT. # 18
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-0900
Practice Address - Country:US
Practice Address - Phone:423-987-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN01-272246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist