Provider Demographics
NPI:1639258122
Name:KIRK, ASHLEY VANCE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:VANCE
Last Name:KIRK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2664 GLENROSE HL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5784
Mailing Address - Country:US
Mailing Address - Phone:404-520-8674
Mailing Address - Fax:
Practice Address - Street 1:1014 SYCAMORE DR
Practice Address - Street 2:STE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1644
Practice Address - Country:US
Practice Address - Phone:404-299-1700
Practice Address - Fax:404-299-1616
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0005972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT000597OtherSTATE LICENSE