Provider Demographics
NPI:1689456634
Name:JOHNSON, ASHLEIGH ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:ELIZABETH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 277723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7723
Mailing Address - Country:US
Mailing Address - Phone:864-560-4123
Mailing Address - Fax:864-560-4023
Practice Address - Street 1:517 CHESNEE HWY STE A
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2709
Practice Address - Country:US
Practice Address - Phone:864-487-7655
Practice Address - Fax:864-487-8718
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6496PAMedicaid
SCSCR441J577OtherMEDICARE PIN