Provider Demographics
NPI:1932702248
Name:BURRISON, NICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHELLE
Middle Name:
Last Name:BURRISON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 EMILY CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-1584
Mailing Address - Country:US
Mailing Address - Phone:770-507-1151
Mailing Address - Fax:
Practice Address - Street 1:2720 HIGHWAY 42 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4301
Practice Address - Country:US
Practice Address - Phone:678-432-9450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist