Individual
ASHLEY SUZAM NORDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
898 COLLEGE ST, SUITE A, MONTICELLO, GA 31064-1258
(706) 468-0988
(706) 468-6631
Mailing address
898 COLLEGE ST, SUITE A, MONTICELLO, GA 31064-1258
(706) 468-0988
(706) 468-6631
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005296
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003141276A
—
GA
Enumeration date
04/14/2008
Last updated
01/30/2014
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