Provider Demographics
NPI:1225087992
Name:LOSEKE, ASHLEY G (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:G
Last Name:LOSEKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120-B OSIGIAN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8939
Mailing Address - Country:US
Mailing Address - Phone:478-953-5358
Mailing Address - Fax:478-953-5340
Practice Address - Street 1:106 MORAN DR
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005
Practice Address - Country:US
Practice Address - Phone:478-988-1282
Practice Address - Fax:478-988-3120
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004318363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant