=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831962059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY MARIE SCOTT FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2023
-----------------------------------------------------
Last Update Date | 11/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 BEAMER CIR SW
-----------------------------------------------------
City | CALHOUN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30701-7800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-324-9532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 460 BEAMER CIR SW
-----------------------------------------------------
City | CALHOUN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30701-7800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-324-9532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN223130
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------