Provider Demographics
NPI:1841415858
Name:ALEXANDER, ASHLI PHILLIPS (MD)
Entity Type:Individual
Prefix:
First Name:ASHLI
Middle Name:PHILLIPS
Last Name:ALEXANDER
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:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-0306
Mailing Address - Country:US
Mailing Address - Phone:678-552-6269
Mailing Address - Fax:
Practice Address - Street 1:11 UPPER RIVERDALE SW RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-996-3190
Practice Address - Fax:770-996-3529
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001966207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I257039Medicare PIN