Healthcare Provider Details

I. General information

NPI: 1508398439
Provider Name (Legal Business Name): ASHLEE BLAKESLEE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 TOWNE CENTRE DR STE 1100
EVANS GA
30809-3329
US

IV. Provider business mailing address

PO BOX 925
AUGUSTA GA
30903-0925
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-3790
  • Fax: 706-863-3794
Mailing address:
  • Phone: 706-724-8611
  • Fax: 706-724-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN206140
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: