MEDICARE: DR. ASHLEY WOOTEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR009721	GA

General Provider Information

NPI Number	:	1013463843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY WOOTEN D.C.

Provider Business Mailing Address
First Line	:	2053 STANTON RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-1311
Country	:	US
Telephone Number	:	404-698-3682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2053 STANTON RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-1311
Country	:	US
Telephone Number	:	404-698-3682
Fax Number	:	833-623-4907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	03/31/2022

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