Healthcare Provider Details

I. General information

NPI: 1306306402
Provider Name (Legal Business Name): ASHLEY PETTAWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 COLONNADE PKWY STE 470
BIRMINGHAM AL
35243-2351
US

IV. Provider business mailing address

1430 GADSDEN HWY STE 116-540
BIRMINGHAM AL
35235-3103
US

V. Phone/Fax

Practice location:
  • Phone: 205-259-6037
  • Fax: 800-961-2371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number81075
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number57189
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number48925
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: