Healthcare Provider Details

I. General information

NPI: 1215430673
Provider Name (Legal Business Name): ASHLEY MCCRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 SUGARLOAF PKWY STE 210
LAWRENCEVILLE GA
30045-9401
US

IV. Provider business mailing address

2080 SUGARLOAF PKWY STE 210
LAWRENCEVILLE GA
30045-9401
US

V. Phone/Fax

Practice location:
  • Phone: 215-485-3954
  • Fax: 478-575-2359
Mailing address:
  • Phone: 215-485-3954
  • Fax: 478-575-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ7952
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP010089
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: