Provider Demographics
NPI:1891314324
Name:GLOUDOUA, ASHONTAE
Entity Type:Individual
Prefix:MRS
First Name:ASHONTAE
Middle Name:
Last Name:GLOUDOUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHONTAE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6742 SONYA DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1154 LIBERTY PIKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5608
Practice Address - Country:US
Practice Address - Phone:205-356-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program