Provider Demographics
NPI:1417242264
Name:ASHBURN, TIMOTHY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARK
Last Name:ASHBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4635 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-8011
Mailing Address - Country:US
Mailing Address - Phone:706-841-0833
Mailing Address - Fax:706-841-0020
Practice Address - Street 1:4635 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-8011
Practice Address - Country:US
Practice Address - Phone:706-841-0833
Practice Address - Fax:706-841-0020
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68698207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129622AMedicaid
GA003129622AMedicaid