Provider Demographics
NPI:1144267923
Name:ASH, WINANS ELLIS JR (CRNA)
Entity type:Individual
Prefix:
First Name:WINANS
Middle Name:ELLIS
Last Name:ASH
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 INDIAN ACRES TRL
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1607
Mailing Address - Country:US
Mailing Address - Phone:404-583-2574
Mailing Address - Fax:
Practice Address - Street 1:TAYLOR AT MARION STREET
Practice Address - Street 2:PALMETTO BAPTIST HOSPITAL
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220-0001
Practice Address - Country:US
Practice Address - Phone:803-296-2276
Practice Address - Fax:803-296-3854
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053795367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS62966Medicare UPIN