MEDICARE: ASHLEY G. LOSEKE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004318	GA

General Provider Information

NPI Number	:	1225087992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY G. LOSEKE PA

Provider Business Mailing Address
First Line	:	120-B OSIGIAN BLVD
Second Line	:	SUITE 100
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-8939
Country	:	US
Telephone Number	:	478-953-5358
Fax Number	:	478-953-5340

Provider Business Practice Location Address
First Line	:	106 MORAN DR
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005
Country	:	US
Telephone Number	:	478-988-1282
Fax Number	:	478-988-3120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	05/19/2009

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