Provider Demographics
NPI:1871009456
Name:GONIEA, ASHLEY NICOLE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:GONIEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 CLEVELAND HWY STE B
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-2052
Mailing Address - Country:US
Mailing Address - Phone:706-852-2374
Mailing Address - Fax:706-852-2375
Practice Address - Street 1:3957 CLEVELAND HWY STE B
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-2052
Practice Address - Country:US
Practice Address - Phone:706-852-2374
Practice Address - Fax:706-852-2375
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA191192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily