MEDICARE: GARLAND ASHLEY REGISTER

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	207Q00000X	Family Medicine Physician	035312	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922160407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARLAND ASHLEY REGISTER

Provider Business Mailing Address
First Line	:	980 4TH ST SE
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-3064
Country	:	US
Telephone Number	:	229-377-2002
Fax Number	:	229-377-0930

Provider Business Practice Location Address
First Line	:	980 4TH ST SE
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-3064
Country	:	US
Telephone Number	:	229-377-2002
Fax Number	:	229-377-0930

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GARLAND ASHLEY REGISTER
Credential	:	MD
Telephone Number	:	229-377-2002

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/22/2020

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