Provider Demographics
NPI:1437485968
Name:BURROUGHS, MELISSA SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUZANNE
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BILL CARRUTH PKWY STE 4200
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-3819
Mailing Address - Country:US
Mailing Address - Phone:678-324-4444
Mailing Address - Fax:
Practice Address - Street 1:144 BILL CARRUTH PKWY STE 4200
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3819
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-17
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110255207R00000X, 207RC0000X
GA88248207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine