Healthcare Provider Details

I. General information

NPI: 1447781240
Provider Name (Legal Business Name): LATISHA K ASHCRAFT BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6429 LEE HWY STE 101
CHATTANOOGA TN
37421-4778
US

IV. Provider business mailing address

3644 PEAVINE RD
CROSSVILLE TN
38571-7923
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-0087
  • Fax: 423-622-0087
Mailing address:
  • Phone: 931-709-0661
  • Fax: 931-709-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number772
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: