Provider Demographics
NPI:1003843723
Name:ASH, CHARLES G (ATC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:G
Last Name:ASH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 FLAVIA CIR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-1611
Mailing Address - Country:US
Mailing Address - Phone:334-566-9419
Mailing Address - Fax:
Practice Address - Street 1:505 FLAVIA CIR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-1611
Practice Address - Country:US
Practice Address - Phone:334-566-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer