Healthcare Provider Details

I. General information

NPI: 1093003493
Provider Name (Legal Business Name): ASHLEY CUMMINS GOTTSHALL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9336 BLAKENEY CENTRE DR STE 100B
CHARLOTTE NC
28277-6694
US

IV. Provider business mailing address

2345 COURT DR
GASTONIA NC
28054-2151
US

V. Phone/Fax

Practice location:
  • Phone: 704-862-4749
  • Fax:
Mailing address:
  • Phone: 704-865-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-02925
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02925
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: