Provider Demographics
NPI:1902835655
Name:ASHLAND FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:ASHLAND FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HENSLEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-354-4139
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251-0067
Mailing Address - Country:US
Mailing Address - Phone:256-354-4139
Mailing Address - Fax:256-354-4137
Practice Address - Street 1:83745 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251
Practice Address - Country:US
Practice Address - Phone:256-354-4139
Practice Address - Fax:256-354-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72349Medicare UPIN