1619924180 NPI number — ASHLEY ESHAM GUY P.A.-C.

Table of content: ASHLEY ESHAM GUY P.A.-C. (NPI 1619924180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619924180 NPI number — ASHLEY ESHAM GUY P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUY
Provider First Name:
ASHLEY
Provider Middle Name:
ESHAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESHAM
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.-C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619924180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
394 FRUIT TREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHOPE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36532-7162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-408-1700
Provider Business Mailing Address Fax Number:
251-633-1997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
EMERGENCY DEPT
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-633-1900
Provider Business Practice Location Address Fax Number:
251-633-1997
Provider Enumeration Date:
05/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA-329 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102I970061 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-35523 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 148739 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".