Healthcare Provider Details

I. General information

NPI: 1578743126
Provider Name (Legal Business Name): SANDRA L ASHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA A WARD ARNP

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N PATTERSON ST
VALDOSTA GA
31602-1735
US

IV. Provider business mailing address

5416 BOYETTE RD
HAHIRA GA
31632-2531
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-1000
  • Fax:
Mailing address:
  • Phone: 229-292-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN148845
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN148845
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29002
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: