Most Relevant Information
Provider Data
| NPI Number: | 1003064734 |
| Provider Name: | ASHLEIGH DERISO |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 075313 |
Most Important Dates
| Enumeration Date: | 09/06/2008 |
| Last Updated: | 09/06/2008 |
Provider Practice Location
1727 WRIGHTSBORO RD
SUITE B
AUGUSTA
GA
309044074
Practice Location Phone/Fax
| Phone: | 7067368170 |
| Fax: | 7067368184 |
Provider Mailing Location
7377 CLARKS MILL RD
LOUISVILLE
GA
304344102
Provider Mailing Phone/Fax
| Phone: | 7066994585 |
| Fax: |