Healthcare Provider Details

I. General information

NPI: 1154369320
Provider Name (Legal Business Name): TIMOTHY ELBERT ASHMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HOSPITAL DR
CAMDEN TN
38320-1617
US

IV. Provider business mailing address

175 HOSPITAL DR
CAMDEN TN
38320-1617
US

V. Phone/Fax

Practice location:
  • Phone: 731-593-6300
  • Fax:
Mailing address:
  • Phone: 731-593-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD31692
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: