Provider Demographics
NPI:1740515063
Name:THOMAS, ASHLEY JANAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:JANAE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:JANAE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:811 13TH ST STE 11
Mailing Address - Street 2:UNIVERSITY PROFESSIONAL BUILDING 3
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2771
Mailing Address - Country:US
Mailing Address - Phone:706-823-6177
Mailing Address - Fax:
Practice Address - Street 1:811 13TH ST STE 11
Practice Address - Street 2:UNIVERSITY PROFESSIONAL BUILDING 3
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2771
Practice Address - Country:US
Practice Address - Phone:706-823-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-04
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005676363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical