Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2465 | GA |
N | 152W00000X | Optometrist | 2810 | TN |
NPI | 1003042888 |
---|---|
Provider Name | Dr. Ashley Ayn Fortney |
First Address | Dacula, GA 30019-0030 |
Second Address | Eastanollee, GA 30538-3808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2009 |
Last Update Date | 14/07/2009 |