Healthcare Provider Details

I. General information

NPI: 1477201366
Provider Name (Legal Business Name): ANSLEY KAYE ULMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

IV. Provider business mailing address

3278 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-2778
  • Fax:
Mailing address:
  • Phone: 229-257-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023041126
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: