Healthcare Provider Details

I. General information

NPI: 1194722397
Provider Name (Legal Business Name): CLAUDE T ASHLEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GROVE PARK LN STE 660
DOTHAN AL
36305-5922
US

IV. Provider business mailing address

200 GROVE PARK LN STE 660
DOTHAN AL
36305-5922
US

V. Phone/Fax

Practice location:
  • Phone: 334-791-6910
  • Fax: 334-459-1619
Mailing address:
  • Phone: 334-791-6910
  • Fax: 334-459-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number00021645
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: