Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | GA |
NPI | 1063171320 |
---|---|
Provider Name | Renita Burrows |
First Address | Lawrenceville, GA 30043-2852 |
Second Address | Lawrenceville, GA 30043-2852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2021 |
Last Update Date | 14/12/2021 |