Provider Demographics
NPI:1114247921
Name:LEZOTTE, ASHLEY WILLIS (NP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:WILLIS
Last Name:LEZOTTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:STE 401
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4293
Mailing Address - Country:US
Mailing Address - Phone:912-466-5443
Mailing Address - Fax:
Practice Address - Street 1:1131 CHAPEL CROSSING RD TRLR 759
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31524-2002
Practice Address - Country:US
Practice Address - Phone:912-280-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145239NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily