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NPI Code Detail

MEDICARE: MISS ASHLEY MCCANN MD

MEDICARE: MISS ASHLEY MCCANN 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
1390200000XStudent in an Organized Health Care Education/Training ProgramIL
2207Q00000XFamily Medicine Physician076369GA

General Provider Information

NPI Number : 1790128486
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ASHLEY MCCANN MD
Provider Business Mailing Address
First Line : 720 WESTVIEW DRIVE SW
Second Line : HARRIS BLDG., 100-A
City : ATLANTA
State : GA
Zip : 30310
Country : US
Telephone Number : 404-756-1400
Fax Number :
Provider Business Practice Location Address
First Line : 1595 CLEVELAND AVE
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3200
Country : US
Telephone Number : 404-616-2886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2013
Last Update Date : 10/23/2018

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