Provider Demographics
NPI:1528322112
Name:KANJIRA, ASHLEY EPHREM (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:EPHREM
Last Name:KANJIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ASHLEY
Other - Middle Name:EPHREM
Other - Last Name:KANJIRATHINGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4575 ADMIRAL RIDGE WAY SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8924
Mailing Address - Country:US
Mailing Address - Phone:770-876-3523
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074528207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine