Provider Demographics
NPI:1295109452
Name:HEAD, ASHLEY RUTH (FNP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RUTH
Last Name:HEAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 LONG PINEY RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:30055-4409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2151 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-3115
Practice Address - Country:US
Practice Address - Phone:770-267-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily