Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN012644 | GA |
N | 1223G0001X | General Practice | DN012644 | GA |
N | 213EG0000X | General Practice | DN012644 | GA |
NPI | 1053390054 |
---|---|
Provider Name | Dr. Eric Thomas Ashley |
First Address | Fort Benning, GA 31905 |
Second Address | Fort Benning, GA 31905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 19/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BA8052211 | FEDERAL DEA (01) |