Provider Demographics
NPI:1821201062
Name:BEASLEY, ASHLEY DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAVIS
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:JAQUAY
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3555 GRANDVIEW PKWY
Mailing Address - Street 2:APT 337
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2028
Mailing Address - Country:US
Mailing Address - Phone:251-404-5731
Mailing Address - Fax:
Practice Address - Street 1:1400 4TH AVE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-329-7200
Practice Address - Fax:205-329-7250
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30235208000000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL166405Medicaid
AL165076Medicaid
AL511-53845OtherBCBS
AL511-53846OtherBCBS