Healthcare Provider Details

I. General information

NPI: 1366848558
Provider Name (Legal Business Name): ASHLEY S. WILSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 16TH AVE
COLUMBUS GA
31901-1665
US

IV. Provider business mailing address

2300 MANCHESTER EXPY STE 2001A
COLUMBUS GA
31904-6802
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-3770
  • Fax:
Mailing address:
  • Phone: 706-320-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN183884
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN183884
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: