MEDICARE: ASHLEY C CAVALIER MD

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	207N00000X	Dermatology Physician	55556	GA

General Provider Information

NPI Number	:	1558366534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY C CAVALIER MD

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	7000 WELLNESS WAY STE 7120
Second Line	:
City	:	ST SIMONS ISLAND
State	:	GA
Zip	:	31522-2286
Country	:	US
Telephone Number	:	912-634-4966
Fax Number	:	912-634-6542

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2024

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