MEDICARE: ASHANTI EPPERSON

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	156FX1800X	Optician	LDO002644	GA

General Provider Information

NPI Number	:	1689355810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHANTI EPPERSON

Provider Business Mailing Address
First Line	:	5830 E 2ND ST STE 70009303
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-4308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 SILVER FOX TRL
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-8282
Country	:	US
Telephone Number	:	470-785-3145
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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Directions to “ ASHANTI EPPERSON ” Practice Location

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