Healthcare Provider Details

I. General information

NPI: 1164671707
Provider Name (Legal Business Name): ASHLEY NICOLE BOACHIE-ADJEI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 MONTREAL RD
TUCKER GA
30084-6900
US

IV. Provider business mailing address

1490 BATES CT NE
BROOKHAVEN GA
30319-3506
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3347
  • Fax:
Mailing address:
  • Phone: 212-606-1852
  • Fax: 212-288-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012785
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number012785
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: