Healthcare Provider Details

I. General information

NPI: 1790398550
Provider Name (Legal Business Name): ASHTON DURON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 TIGER PAW ST S
MEMPHIS TN
38152-3920
US

IV. Provider business mailing address

6370 SANDHURST RD
HORN LAKE MS
38637-2056
US

V. Phone/Fax

Practice location:
  • Phone: 901-584-8281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: