MEDICARE: MR. THOMAS ASHLEY KEITH JR. CSFA

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	246ZC0007X	Surgical Assistant	177948	TN

General Provider Information

NPI Number	:	1134825672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ASHLEY KEITH JR. CSFA

Provider Business Mailing Address
First Line	:	3001 KNOLL TOP LN APT 3004
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-1571
Country	:	US
Telephone Number	:	910-617-8886
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 KNOLL TOP LN APT 3004
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-1571
Country	:	US
Telephone Number	:	910-617-8886
Fax Number	:

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

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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