Individual
ASHLEY L JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
655 SEVENTH STREET, BLDG 700, CENTERVILLE, GA 31028
(303) 931-8976
Mailing address
105 VALENCIA CIR, CENTERVILLE, GA 31028-1339
(303) 931-8976
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/29/2012
Last updated
05/12/2015
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