Provider Demographics
NPI:1508647090
Name:ASHE, DWAN Y (LMT NMT MLD-C)
Entity Type:Individual
Prefix:
First Name:DWAN
Middle Name:Y
Last Name:ASHE
Suffix:
Gender:F
Credentials:LMT NMT MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 GLENEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-5049
Mailing Address - Country:US
Mailing Address - Phone:229-854-6801
Mailing Address - Fax:
Practice Address - Street 1:1122 W BROAD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-4340
Practice Address - Country:US
Practice Address - Phone:678-480-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
FLMA97449225700000X
GAMT005624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach