Provider Demographics
NPI:1487889036
Name:ELAM-BRYANT, ASHLA YUSHER (PA)
Entity type:Individual
Prefix:MRS
First Name:ASHLA
Middle Name:YUSHER
Last Name:ELAM-BRYANT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 SATELLITE BLVD
Mailing Address - Street 2:APT. 723
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2328
Mailing Address - Country:US
Mailing Address - Phone:706-573-3883
Mailing Address - Fax:
Practice Address - Street 1:7794 ELLA LN
Practice Address - Street 2:#G
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-5511
Practice Address - Country:US
Practice Address - Phone:770-626-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005575363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical