Provider Demographics
NPI:1538498860
Name:GEORGE, ASHLEY DAWN
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:DAWN
Last Name:GEORGE
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 1:3272 GRADY RD
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744
Mailing Address - Country:US
Mailing Address - Phone:601-562-0079
Mailing Address - Fax:601-743-2648
Practice Address - Street 1:1451 N LAKELAND DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-9020
Practice Address - Country:US
Practice Address - Phone:601-483-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MSS3420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist