MEDICARE: DWAN Y ASHE LMT NMT MLD-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA97449	FL
2	174H00000X	Health Educator
3	174400000X	Specialist
4	374J00000X	Doula
5	171400000X	Health & Wellness Coach
6	225700000X	Massage Therapist	MT005624	GA
7	174N00000X	Lactation Consultant (Non-RN)
8	172V00000X	Community Health Worker		GA
9	173C00000X	Reflexologist

General Provider Information

NPI Number	:	1508647090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWAN Y ASHE LMT NMT MLD-C

Provider Business Mailing Address
First Line	:	2307 GLENEAGLES DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-5049
Country	:	US
Telephone Number	:	229-854-6801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 W BROAD AVE
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-4340
Country	:	US
Telephone Number	:	678-408-1191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	03/18/2026

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