Provider Demographics
NPI:1275859050
Name:WANAGER, ASHLEY M (NP-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:WANAGER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:KATHLEEN
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-4750
Mailing Address - Fax:912-350-4751
Practice Address - Street 1:4700 WATERS AVE STE 507
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-4750
Practice Address - Fax:912-350-4751
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00869902OtherRR MEDICARE
SCNP1625Medicaid
GA127207973AMedicaid
GA01382063OtherAMERIGROUP
SCNP1625Medicaid