Healthcare Provider Details

I. General information

NPI: 1710906797
Provider Name (Legal Business Name): VICTORY LEIGH ASHMORE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PEACHTREE DUNWOODY RD G-51
ATLANTA GA
30342-1703
US

IV. Provider business mailing address

5555 PEACHTREE DUNWOODY RD G-51
ATLANTA GA
30342-1703
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-1216
  • Fax:
Mailing address:
  • Phone: 404-250-1216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD0003499
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: