Provider Demographics
NPI:1124691738
Name:NAGEL, ASHLEY PETER
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PETER
Last Name:NAGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-0003
Mailing Address - Country:US
Mailing Address - Phone:912-884-9255
Mailing Address - Fax:
Practice Address - Street 1:204 BUTLER ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-4596
Practice Address - Country:US
Practice Address - Phone:912-884-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist