Healthcare Provider Details

I. General information

NPI: 1477127736
Provider Name (Legal Business Name): ASHLEY GILVYDIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 08/26/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

205 N EAST AVE
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-3994
  • Fax: 517-205-7050
Mailing address:
  • Phone: 517-205-3994
  • Fax: 517-205-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4351048106
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: