Provider Demographics
NPI:1831685106
Name:COLVIN, ASHLEY LORRAINE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LORRAINE
Last Name:COLVIN
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 1:4495 ATLANTA HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6731
Mailing Address - Country:US
Mailing Address - Phone:770-554-3456
Mailing Address - Fax:
Practice Address - Street 1:4495 ATLANTA HWY STE 300
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6731
Practice Address - Country:US
Practice Address - Phone:770-554-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT003090OtherOPTOMETRY LICENSE