Provider Demographics
NPI:1346094331
Name:BUSSEY, ASHLI NICOLE
Entity Type:Individual
Prefix:
First Name:ASHLI
Middle Name:NICOLE
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 ROPER ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-4031
Mailing Address - Country:US
Mailing Address - Phone:912-592-2817
Mailing Address - Fax:
Practice Address - Street 1:1101 GASKIN AVE N
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3021
Practice Address - Country:US
Practice Address - Phone:912-592-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172A00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172A00000XOther Service ProvidersDriver