Provider Demographics
NPI:1124289285
Name:ASBURY, TORI (DO)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:ASBURY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:ASBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-454-4032
Mailing Address - Fax:910-454-4033
Practice Address - Street 1:1456 HOWE STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2674
Practice Address - Country:US
Practice Address - Phone:910-454-4032
Practice Address - Fax:910-454-4033
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000002241207Q00000X
VA0116020620207Q00000X
NC2014-01013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528129Medicaid
TN4309868OtherBCBS TN
TN103I084471Medicare PIN