Provider Demographics
NPI:1316263494
Name:CANNON, ASHLEA L (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEA
Middle Name:L
Last Name:CANNON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEA
Other - Middle Name:L
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1755 HWY 34 E
Mailing Address - Street 2:STE 2200
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-3190
Mailing Address - Country:US
Mailing Address - Phone:770-254-7843
Mailing Address - Fax:770-683-6643
Practice Address - Street 1:1755 HWY 34 E
Practice Address - Street 2:STE 2200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3190
Practice Address - Country:US
Practice Address - Phone:770-502-2175
Practice Address - Fax:770-254-7843
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005659363A00000X
GA5569363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA146816327CMedicaid
GA20297I3315Medicare PIN