Healthcare Provider Details

I. General information

NPI: 1114139300
Provider Name (Legal Business Name): EDWARD ASHLEY CARRAWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 UNIVERSITY BLVD. EAST SUITE 400
TUSCALOOSA AL
35401-7428
US

IV. Provider business mailing address

701 UNIVERSITY BLVD. EAST SUITE 400
TUSCALOOSA AL
35401-7428
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-0694
  • Fax: 205-752-6244
Mailing address:
  • Phone: 205-752-0694
  • Fax: 205-752-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27723
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number27723
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: