Healthcare Provider Details

I. General information

NPI: 1063603249
Provider Name (Legal Business Name): ASHLEY WOLCHINA ALLISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 INDEPENDENCE DR SUITE 301
HOMEWOOD AL
35209-4159
US

IV. Provider business mailing address

3125 INDEPENDENCE DR SUITE 301
HOMEWOOD AL
35209-4159
US

V. Phone/Fax

Practice location:
  • Phone: 205-879-2260
  • Fax: 205-879-2261
Mailing address:
  • Phone: 205-879-2260
  • Fax: 205-879-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberBP1-0029875
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD.28090
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD.28090
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: