Provider Demographics
NPI:1851087365
Name:MULLIS, ASHLEY SOUZA (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SOUZA
Last Name:MULLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 3RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3293
Mailing Address - Country:US
Mailing Address - Phone:478-464-2600
Mailing Address - Fax:478-742-2040
Practice Address - Street 1:610 3RD ST STE 101
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3293
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:478-742-2040
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279230363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily