Provider Demographics
NPI:1447770532
Name:POULLARD, ASHLEY DEKIRA (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DEKIRA
Last Name:POULLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2721
Mailing Address - Country:US
Mailing Address - Phone:678-289-6747
Mailing Address - Fax:678-289-6750
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4357
Practice Address - Country:US
Practice Address - Phone:783-416-6370
Practice Address - Fax:770-509-0601
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA85066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine