Provider Demographics
NPI:1861569956
Name:ASHLEY, JOHN HOWARD IV (PA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HOWARD
Last Name:ASHLEY
Suffix:IV
Gender:M
Credentials:PA
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Mailing Address - Street 1:11700 MERCY BLVD
Mailing Address - Street 2:#6 PLAZA D
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1753
Mailing Address - Country:US
Mailing Address - Phone:912-927-3434
Mailing Address - Fax:912-927-5016
Practice Address - Street 1:11700 MERCY BLVD
Practice Address - Street 2:#6 PLAZA D
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-927-3434
Practice Address - Fax:912-927-5016
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-06-09
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Provider Licenses
StateLicense IDTaxonomies
GA004238363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA207643155AMedicaid
GA97WCJGDMedicare PIN
GA207643155AMedicaid