Basic Information
| Provider Information | |||||||||
| NPI: | 1205815347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5445 MERIDIAN MARK RD | ||||||||
| Address2: | STE 250 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303424767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042551933 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5445 MERIDIAN MARK RD | ||||||||
| Address2: | STE 250 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303424767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042551933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2006 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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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 | 363AM0700X | 004553 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | 4553 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 721491758A | 05 | GA | MEDICAID |