Healthcare Provider Details

I. General information

NPI: 1073441564
Provider Name (Legal Business Name): ANSLEY CAROLINE HARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 HORSESHOE COVE RD
WAVERLY GA
31565-2110
US

IV. Provider business mailing address

3410 BROADHURST RD
JESUP GA
31546-0426
US

V. Phone/Fax

Practice location:
  • Phone: 912-553-2172
  • Fax: 912-480-4353
Mailing address:
  • Phone: 912-424-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET004468
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: