Provider Demographics
NPI:1467060517
Name:SPROUSE, ASHLEIGH MARIE (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:MARIE
Last Name:SPROUSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6368
Mailing Address - Country:US
Mailing Address - Phone:678-595-2806
Mailing Address - Fax:
Practice Address - Street 1:1190 GRIMES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3930
Practice Address - Country:US
Practice Address - Phone:770-992-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist