Provider Demographics
NPI:1437578879
Name:ASHFORD CLINIC, LLC
Entity Type:Organization
Organization Name:ASHFORD CLINIC, LLC
Other - Org Name:ASHFORD EAR CLINIC, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-248-6860
Mailing Address - Street 1:1000 HAWTHORNE AVE
Mailing Address - Street 2:SUITE T
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2168
Mailing Address - Country:US
Mailing Address - Phone:706-248-6860
Mailing Address - Fax:706-248-6142
Practice Address - Street 1:1000 HAWTHORNE AVE
Practice Address - Street 2:SUITE T
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-248-6860
Practice Address - Fax:706-248-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071659207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty