Provider Demographics
NPI:1740223635
Name:ASHCRAFT, DELMON E JR (MD)
Entity Type:Individual
Prefix:
First Name:DELMON
Middle Name:E
Last Name:ASHCRAFT
Suffix:JR
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 1:2550 BUSINESS PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-6503
Mailing Address - Country:US
Mailing Address - Phone:423-339-8881
Mailing Address - Fax:423-464-6126
Practice Address - Street 1:2550 BUSINESS PARK DR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-6503
Practice Address - Country:US
Practice Address - Phone:423-339-8881
Practice Address - Fax:423-464-6126
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28960207V00000X
GA043319207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017707Medicaid
TN3811959Medicaid
GA000741903AMedicaid
TN3060982OtherTN MEDICAID
GA700174OtherGA BCBS
GA000741903AMedicaid
GA16BDBFZKMedicare ID - Type UnspecifiedGA MEDICARE
TN3811959Medicaid