Healthcare Provider Details

I. General information

NPI: 1134869399
Provider Name (Legal Business Name): ASHLEY SHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 HUDSON BRIDGE RD
STOCKBRIDGE GA
30281-5020
US

IV. Provider business mailing address

1510 HUDSON BRIDGE RD
STOCKBRIDGE GA
30281-5020
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-8660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number104478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: