Basic Information
| Provider Information | |||||||||
| NPI: | 1023354065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGUIRE-TANKSLEY | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| OtherLastName: | MCGUIRE | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1301 SIGMAN RD NE | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300123812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709224024 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1412 MILSTEAD AVE NE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300123877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709224024 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2012 | ||||||||
| LastUpdateDate: | 02/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 6697 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.