MEDICARE: DR. ASHLEY PETTAWAY MD

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	2084P0800X	Psychiatry Physician	81075	MN
2	2084P0800X	Psychiatry Physician	48925	AL
3	2084P0800X	Psychiatry Physician	57189	KY

General Provider Information

NPI Number	:	1306306402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY PETTAWAY MD

Provider Business Mailing Address
First Line	:	1430 GADSDEN HWY STE 116-540
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2016 STONEGATE TRL
Second Line	:
City	:	VESTAVIA HLS
State	:	AL
Zip	:	35242-2260
Country	:	US
Telephone Number	:	205-259-6033
Fax Number	:

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

Provider Enumeration Date	:	03/23/2019
Last Update Date	:	10/15/2025

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Directions to “ DR. ASHLEY PETTAWAY MD” Practice Location

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