Provider Demographics
NPI:1104900968
Name:ASHLEY, JON STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:STEPHEN
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-1410
Mailing Address - Country:US
Mailing Address - Phone:662-459-2613
Mailing Address - Fax:662-459-1159
Practice Address - Street 1:1401 RIVER RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4030
Practice Address - Country:US
Practice Address - Phone:662-459-2613
Practice Address - Fax:662-459-1159
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12084146N00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01713169OtherRAILROAD MEDICARE PTAN
MS000121529Medicaid
MSP01713169OtherRAILROAD MEDICARE PTAN
MS485053YWZ1Medicare PIN
MSP01713169OtherRAILROAD MEDICARE PTAN