Healthcare Provider Details

I. General information

NPI: 1679514988
Provider Name (Legal Business Name): JAMES C. ASHWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/16/2021
Certification Date: 10/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 KOMAS DR SUITE 200
SALT LAKE CITY UT
84108-1215
US

IV. Provider business mailing address

501 CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-5515
  • Fax:
Mailing address:
  • Phone: 801-587-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number1879571205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number187957-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: