Provider Demographics
NPI:1104069228
Name:THEDFORD ADLEY, LASHAUNDRA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LASHAUNDRA
Middle Name:MARIE
Last Name:THEDFORD ADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LASHAUNDRA
Other - Middle Name:MARIE
Other - Last Name:THEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3004 ALLISON BONNETT MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2317
Mailing Address - Country:US
Mailing Address - Phone:052-491-3299
Mailing Address - Fax:205-744-4072
Practice Address - Street 1:3004 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2317
Practice Address - Country:US
Practice Address - Phone:205-491-3299
Practice Address - Fax:205-744-4072
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.37174208000000X, 207R00000X
TXP7361208000000X
AL37174208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321798YN3VMedicare PIN