Basic Information
| Provider Information | |||||||||
| NPI: | 1013193549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | CONNOR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1707 | ||||||||
| Address2: | |||||||||
| City: | MILLEDGEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310591707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784572036 | ||||||||
| FaxNumber: | 4784542042 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 N COBB ST | ||||||||
| Address2: | |||||||||
| City: | MILLEDGEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310612343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784572036 | ||||||||
| FaxNumber: | 4784542042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2008 | ||||||||
| LastUpdateDate: | 03/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 002107 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 003100816A | 05 | GA | MEDICAID |