Basic Information
| Provider Information | |||||||||
| NPI: | 1144463308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | AUSTIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MED, ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 WISTERIA DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300782689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709820102 | ||||||||
| FaxNumber: | 7709820130 | ||||||||
| Practice Location | |||||||||
| Address1: | 1735 BUFORD HWY | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300411266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708870502 | ||||||||
| FaxNumber: | 7708870054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2009 | ||||||||
| LastUpdateDate: | 10/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT0001543 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.