Provider Demographics
NPI:1063776615
Name:GARDNER, ASHLEIGH BROOKE (DO)
Entity type:Individual
Prefix:DR
First Name:ASHLEIGH
Middle Name:BROOKE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:525 VERDAE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4021
Mailing Address - Country:US
Mailing Address - Phone:864-272-0388
Mailing Address - Fax:864-213-9237
Practice Address - Street 1:211 BATESVILLE RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4816
Practice Address - Country:US
Practice Address - Phone:864-272-0388
Practice Address - Fax:864-213-9237
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC37707208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics