Healthcare Provider Details

I. General information

NPI: 1447073929
Provider Name (Legal Business Name): ASHLEY GRACE THOMAS RAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 J L WHITE DR STE 160
JASPER GA
30143-4910
US

IV. Provider business mailing address

1020 J L WHITE DR STE 160
JASPER GA
30143-4910
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-0603
  • Fax:
Mailing address:
  • Phone: 770-378-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: