Provider Demographics
NPI:1700833688
Name:O'SHIELDS, ASHLEY E (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:O'SHIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 GEORGIA HIGHWAY 400 FL 1
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-3460
Mailing Address - Country:US
Mailing Address - Phone:706-429-9965
Mailing Address - Fax:470-239-4080
Practice Address - Street 1:6470 GEORGIA HIGHWAY 400 FL 1
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-3460
Practice Address - Country:US
Practice Address - Phone:706-429-9965
Practice Address - Fax:470-239-4080
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA013147676EMedicaid