Individual
ASHLEY LORRAINE COLVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4495 ATLANTA HWY STE 300, LOGANVILLE, GA 30052-6731
(770) 554-3456
Mailing address
4495 ATLANTA HWY STE 300, LOGANVILLE, GA 30052-6731
(770) 554-3456
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT003090
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT003090
OPTOMETRY LICENSE
GA
Enumeration date
07/10/2018
Last updated
04/17/2023
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