Healthcare Provider Details

I. General information

NPI: 1104646314
Provider Name (Legal Business Name): ASHLEY NICOLE SEGNOU NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2738 N DECATUR RD
DECATUR GA
30033-5910
US

IV. Provider business mailing address

2738 N DECATUR RD
DECATUR GA
30033-5910
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN204968
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: