Ashonta Dee Gresham, THERAPIST

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

License

COSA065559 Issued in GA

Practice address

613 Roberts Dr Ste E
Riverdale, GA 30274-2913

Phone

(404) 566-0035

NPI assigned

Jun 20, 2023

Last updated

Apr 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1114602836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 ROBERTS DR STE E",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742913",
            "telephone_number": "404-566-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 ROBERTS DR STE E",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742913",
            "telephone_number": "404-566-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRESHAM",
        "first_name": "ASHONTA",
        "middle_name": "DEE",
        "credential": "THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-20",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "GA",
            "license": "COSA065559",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "COSA065559",
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "GA",
            "license": "COSA065559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health & Wellness Coach in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Health & Wellness Coach in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.