Healthcare Provider Details

I. General information

NPI: 1497691885
Provider Name (Legal Business Name): ASHLEY REBECCA MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MILLARD FARMER IND BLVD
NEWNAN GA
30263-1012
US

IV. Provider business mailing address

65 COLD HARBOR CT
SHARPSBURG GA
30277-3383
US

V. Phone/Fax

Practice location:
  • Phone: 770-746-3342
  • Fax:
Mailing address:
  • Phone: 407-701-9135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124190
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: