Provider Demographics
NPI:1821607409
Name:MADER, ASHLEIGH BROOKE (APRN)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:BROOKE
Last Name:MADER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5461 MERIDIAN MARK RD STE 570
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2807
Mailing Address - Country:US
Mailing Address - Phone:404-785-6895
Mailing Address - Fax:
Practice Address - Street 1:5461 MERIDIAN MARK RD STE 570
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2807
Practice Address - Country:US
Practice Address - Phone:404-785-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006877363LA2100X
GAGAA-NP000522363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care