Provider Demographics
NPI:1205815347
Name:THOMAS, ASHLEY D (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 MERIDIAN MARK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4767
Mailing Address - Country:US
Mailing Address - Phone:404-255-1933
Mailing Address - Fax:
Practice Address - Street 1:5445 MERIDIAN MARK RD
Practice Address - Street 2:STE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4767
Practice Address - Country:US
Practice Address - Phone:404-255-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004553363AM0700X
GA4553363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA721491758AMedicaid
Q47154Medicare UPIN
GA721491758AMedicaid