Provider Demographics
NPI:1942724919
Name:POAGUE, ANSLEY (FNPC)
Entity Type:Individual
Prefix:
First Name:ANSLEY
Middle Name:
Last Name:POAGUE
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:ANSLEY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3419
Mailing Address - Country:US
Mailing Address - Phone:229-758-3002
Mailing Address - Fax:229-758-9415
Practice Address - Street 1:103 W PINE ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3526
Practice Address - Country:US
Practice Address - Phone:229-758-3002
Practice Address - Fax:229-758-9415
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty