Basic Information
| Provider Information | |||||||||
| NPI: | 1770829798 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHADE | ||||||||
| FirstName: | ANTONIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 935722 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311935722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437926200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 805 PAMPLICO HWY | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295056047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437921414 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2012 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TRN21570 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD83774 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME134799 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 79699 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 83774 | SC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | GA2282 | 05 | SC | MEDICAID |