Healthcare Provider Details

I. General information

NPI: 1922822873
Provider Name (Legal Business Name): ANSLEY CAIN ROSS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 FAIRBANKS DR
OAKWOOD GA
30566-2811
US

IV. Provider business mailing address

411 MULBERRY CREEK CT
PENDERGRASS GA
30567-3932
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-6053
  • Fax:
Mailing address:
  • Phone: 229-407-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP311424
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN311424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: