Basic Information
| Provider Information | |||||||||
| NPI: | 1952622045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GHIASEDDIN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | PARHAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100265 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522739000 | ||||||||
| FaxNumber: | 3523928413 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326102859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522739000 | ||||||||
| FaxNumber: | 3523928413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2010 | ||||||||
| LastUpdateDate: | 04/25/2018 | ||||||||
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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 | 2084N0400X | ME123777 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 015047300 | 05 | FL | MEDICAID |