Provider Demographics
NPI:1427637552
Name:BURROWS, CAROLINE REBECCA (PAC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:REBECCA
Last Name:BURROWS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 OLDE TOWNE PKWY STE 360
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4396
Mailing Address - Country:US
Mailing Address - Phone:770-971-1533
Mailing Address - Fax:770-971-4846
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 360
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4396
Practice Address - Country:US
Practice Address - Phone:770-971-1533
Practice Address - Fax:770-971-4846
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty