Provider Demographics
NPI:1265606446
Name:CELIO O. BURROWES MD PC
Entity type:Organization
Organization Name:CELIO O. BURROWES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELIO
Authorized Official - Middle Name:ORFACIO
Authorized Official - Last Name:BURROWES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-904-1606
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:678-904-1606
Mailing Address - Fax:678-904-2522
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 515
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:678-904-1606
Practice Address - Fax:678-904-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA020041641OtherMEDICARE RAILROAD
GA000666289CMedicaid