Provider Demographics
NPI:1699930859
Name:AUSTIN, ASHLEY LAUREN (DO)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LAUREN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DO
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 4018
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-4018
Mailing Address - Country:US
Mailing Address - Phone:423-282-1480
Mailing Address - Fax:423-928-1353
Practice Address - Street 1:1 MEDICAL PARK BLVD STE 350W
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7471
Practice Address - Country:US
Practice Address - Phone:423-282-1480
Practice Address - Fax:423-928-1353
Is Sole Proprietor?:No
Enumeration Date:2008-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699930859Medicaid
TN1524449Medicaid
TN3706263Medicare UPIN
TN3735664Medicare UPIN
TN3706267Medicare UPIN
TN103I087707Medicare PIN
TN1508353Medicare UPIN
TN1515079Medicare UPIN
TN1520040Medicare UPIN
TN1524449Medicaid
TN1532903Medicare UPIN
VA1699930859Medicaid