Provider Demographics
NPI:1790487569
Name:MARSHALL, ASTRIA (OWNER)
Entity Type:Individual
Prefix:MS
First Name:ASTRIA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:MS
Other - First Name:ASTRIA
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1045 FLINT HILL HWY
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:GA
Mailing Address - Zip Code:31826-3507
Mailing Address - Country:US
Mailing Address - Phone:706-977-4366
Mailing Address - Fax:
Practice Address - Street 1:1045 FLINT HILL HWY
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:GA
Practice Address - Zip Code:31826-3507
Practice Address - Country:US
Practice Address - Phone:706-977-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health