Basic Information
| Provider Information | |||||||||
| NPI: | 1174149520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUGLAS | ||||||||
| FirstName: | ASHTON | ||||||||
| MiddleName: | GRACE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 CIRCLE 75 PKWY SE STE 1400 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789813543 | ||||||||
| FaxNumber: | 4047771311 | ||||||||
| Practice Location | |||||||||
| Address1: | 3135 PEOPLES ST STE 404 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376044138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234541006 | ||||||||
| FaxNumber: | 4233287825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2020 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12903 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 12903 | 01 | TN | MEDRISK | OTHER | 12903 | 05 | TN | MEDICAID | 12903 | 01 | TN | TRI-CARE | OTHER | 12903 | 01 | TN | COMMERCIAL | OTHER | 12903 | 01 | TN | MEDICARE REPLACEMENT | OTHER | 12903 | 01 | TN | TRIWEST | OTHER | 12903 | 01 | TN | WORKER'S COMPENSATION | OTHER |