Healthcare Provider Details

I. General information

NPI: 1861077745
Provider Name (Legal Business Name): JOY LYNNE ASHWORTH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 CHURCH ST NE STE 220
MARIETTA GA
30060-1116
US

IV. Provider business mailing address

699 CHURCH ST NE STE 220
MARIETTA GA
30060-1116
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-8505
  • Fax: 678-819-7475
Mailing address:
  • Phone: 770-422-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN213864
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: