Provider Demographics
NPI: | 1821084849 |
---|---|
Name: | ASHMORE, MICHAEL E (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | E |
Last Name: | ASHMORE |
Suffix: | |
Gender: | M |
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: | 3155 NORTH POINT PARKWAY |
Mailing Address - Street 2: | ATTN: CREDENTIALING DEPT. BUILDING F SUITE 100 |
Mailing Address - City: | ALPHARETTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30004 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 770-645-9181 |
Mailing Address - Fax: | 770-645-8455 |
Practice Address - Street 1: | 1000 JOHNSON FERRY RD NE |
Practice Address - Street 2: | |
Practice Address - City: | ATLANTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30342-1606 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-645-9181 |
Practice Address - Fax: | 770-645-8455 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-09-26 |
Last Update Date: | 2013-08-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 27024 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | 000331658C | Medicaid | |
GA | 000331658D | Medicaid | |
GA | 000331658E | Medicaid | |
GA | 000331658E | Medicaid | |
GA | 000331658D | Medicaid | |
GA | 05BDGHG | Medicare PIN |