Provider Demographics
NPI:1972959492
Name:INGRAM, ALLYSON MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:MICHELLE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ALLYSON
Other - Middle Name:MICHELLE
Other - Last Name:EUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27533-9710
Mailing Address - Country:US
Mailing Address - Phone:919-580-0004
Mailing Address - Fax:919-580-9099
Practice Address - Street 1:462 ELMA G MILES PKWY STE 102A
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4000
Practice Address - Country:US
Practice Address - Phone:912-369-9310
Practice Address - Fax:912-877-3102
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001006436363A00000X
GA9473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-06436OtherNC MEDICAL LICENSE