Provider Demographics
NPI:1851066963
Name:SORRELL, ASHLEY CRAIG
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CRAIG
Last Name:SORRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-7326
Mailing Address - Country:US
Mailing Address - Phone:229-415-8353
Mailing Address - Fax:
Practice Address - Street 1:2744 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7326
Practice Address - Country:US
Practice Address - Phone:229-415-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor