Provider Demographics
NPI:1780684456
Name:ASHLEY, THOMAS LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LOUIS
Last Name:ASHLEY
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-1576
Practice Address - Fax:864-560-1590
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18103208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
S396821OtherCIGNA
NC7905997Medicaid
020042141OtherRAILROAD MEDICARE
SCT18996Medicaid
SC020031390Medicare PIN
SCAA46723365Medicare PIN
E16187Medicare UPIN
SCAA4672768Medicare PIN