Healthcare Provider Details

I. General information

NPI: 1497576698
Provider Name (Legal Business Name): ASHLEY NICOLE BELTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CLIFTON RD NE FL 2
ATLANTA GA
30322-4200
US

IV. Provider business mailing address

1525 CLIFTON RD NE FL 2
ATLANTA GA
30322-4200
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-0390
  • Fax:
Mailing address:
  • Phone: 404-727-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number222134
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: