Healthcare Provider Details

I. General information

NPI: 1932023330
Provider Name (Legal Business Name): SINCLAIR AUTUMN ASHLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 PINE LOG RD NE APT B
CONYERS GA
30012-7100
US

IV. Provider business mailing address

1464 PINE LOG RD NE APT B
CONYERS GA
30012-7100
US

V. Phone/Fax

Practice location:
  • Phone: 971-258-7901
  • Fax: 971-258-7901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberA337614
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: