Basic Information
| Provider Information | |||||||||
| NPI: | 1053810424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABT | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S MADISON ST | ||||||||
| Address2: | |||||||||
| City: | THOMASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317925473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292360831 | ||||||||
| FaxNumber: | 2292360871 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 E STEPHENS ST | ||||||||
| Address2: | |||||||||
| City: | CAMILLA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317301836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293364600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2018 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN244930 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.