Basic Information
Provider Information
NPI: 1245813955
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRAIG
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2807 GREYSTONE COMMERCIAL BLVD
Address2: UNIT 38
City: BIRMINGHAM
State: AL
PostalCode: 352429601
CountryCode: US
TelephoneNumber: 2059951001
FaxNumber:  
Practice Location
Address1: 2807 GREYSTONE COMMERCIAL BLVD
Address2: UNIT 38
City: BIRMINGHAM
State: AL
PostalCode: 352429601
CountryCode: US
TelephoneNumber: 2059951009
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/30/2021
LastUpdateDate: 09/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102X1-147560ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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