Provider Demographics
NPI:1033370192
Name:ASBURY, JUSTIN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:E
Last Name:ASBURY
Suffix:
Gender:M
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 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:910-721-4100
Mailing Address - Fax:910-721-4101
Practice Address - Street 1:509 OLDE WATERFORD WAY STE 200
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4126
Practice Address - Country:US
Practice Address - Phone:910-408-1130
Practice Address - Fax:910-408-1135
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
NC201401070207Q00000X
VA0116020621207Q00000X
TNDO0000002240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526786Medicaid
TN4309333OtherBCBS
TN4309333OtherBCBS