Provider Demographics
NPI:1013193549
Name:RYAN, ASHLEY CONNOR (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CONNOR
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1707
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1707
Mailing Address - Country:US
Mailing Address - Phone:478-457-2036
Mailing Address - Fax:478-454-2042
Practice Address - Street 1:821 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2343
Practice Address - Country:US
Practice Address - Phone:478-457-2036
Practice Address - Fax:478-454-2042
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA002107207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100816AMedicaid
GA202I056919Medicare PIN