Provider Demographics
NPI:1699359778
Name:GRAY, ASHLEY BURGIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BURGIN
Last Name:GRAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:MICHELLE
Other - Last Name:BURGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 WYNGATE DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1296
Mailing Address - Country:US
Mailing Address - Phone:678-850-8537
Mailing Address - Fax:
Practice Address - Street 1:45 WYNGATE DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1296
Practice Address - Country:US
Practice Address - Phone:678-850-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily