Healthcare Provider Details

I. General information

NPI: 1225415581
Provider Name (Legal Business Name): ASHLEY GILLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 NOAH DR STE 108
JASPER GA
30143-8704
US

IV. Provider business mailing address

744 NOAH DR STE 108
JASPER GA
30143-8704
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN215446
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: