Provider Demographics
NPI:1578750568
Name:JOHNSON, ASHLEIGH LEWIS (PAC)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:LEWIS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:LEWIS
Other - Last Name:RENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:823 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0209
Mailing Address - Country:US
Mailing Address - Phone:912-456-3755
Mailing Address - Fax:912-303-7727
Practice Address - Street 1:823 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0209
Practice Address - Country:US
Practice Address - Phone:912-456-3755
Practice Address - Fax:912-303-7727
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5151363A00000X
GA005151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant