Provider Demographics
NPI:1720032063
Name:OLIVER, ASHLEY LYN (CRNA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 WARREN STREET NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317
Mailing Address - Country:US
Mailing Address - Phone:585-748-6240
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD, NE
Practice Address - Street 2:RM B344
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-5778
Practice Address - Fax:404-778-5194
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN178101367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ15470Medicare UPIN
GA43BBBRHMedicare PIN