Provider Demographics
NPI:1740223635
Name:ASHCRAFT, DELMON E JR (MD)
Entity type:Individual
Prefix:
First Name:DELMON
Middle Name:E
Last Name:ASHCRAFT
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:929 SPRING CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3974
Practice Address - Country:US
Practice Address - Phone:423-629-9744
Practice Address - Fax:423-629-9743
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28960208M00000X
TNMD28960207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000741903AMedicaid
GA700174OtherGA BCBS
TNQ017707Medicaid
TN3060982OtherTN MEDICAID
TN3811959Medicaid
GA000741903AMedicaid
GA16BDBFZKMedicare ID - Type UnspecifiedGA MEDICARE
TN3811959Medicaid