Provider Demographics
NPI:1922160407
Name:GARLAND ASHLEY REGISTER
Entity Type:Organization
Organization Name:GARLAND ASHLEY REGISTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARLAND
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-377-2002
Mailing Address - Street 1:980 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-3064
Mailing Address - Country:US
Mailing Address - Phone:229-377-2002
Mailing Address - Fax:229-377-0930
Practice Address - Street 1:980 4TH ST SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3064
Practice Address - Country:US
Practice Address - Phone:229-377-2002
Practice Address - Fax:229-377-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00503654AMedicaid
GA08BDDMKMedicare ID - Type Unspecified
GA00503654AMedicaid