Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 002107 | GA |
NPI | 1013193549 |
---|---|
Provider Name | Ashley Connor Ryan |
First Address | Milledgeville, GA 31059-1707 |
Second Address | Milledgeville, GA 31061-2343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 08/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003100816A | (05) | GA |