Doctor Name: | MRS. ASHLA YUSHER ELAM-BRYANT |
NPI Number: | 1487889036 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 005575 |
Business Practice Address: | 7794 Ella Ln #g Fairburn, GA - 302135511 |
Business Phone Number: | 7706264350 |
Business Fax Number: | |
Mailing Address: | 2951 Satellite Blvd, Apt. 723 DULUTH |
State: | GA |
Postal Code: | 300962328 |
Phone Number: | 7065733883 |
Fax Number: | |
NPI Enumeration Date: | 05/27/2009 |
NPI Last Update Date: | 06/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 005575 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |