Provider Demographics
NPI:1336912955
Name:REAVES, ASHLYNN EARLINE
Entity Type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:EARLINE
Last Name:REAVES
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 1:1201 W PEACHTREE ST NW # 795559
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3449
Mailing Address - Country:US
Mailing Address - Phone:678-768-2061
Mailing Address - Fax:
Practice Address - Street 1:2020 OLD ALABAMA RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4923
Practice Address - Country:US
Practice Address - Phone:678-768-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010166225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist