Provider Demographics
NPI:1174149520
Name:DOUGLAS, ASHTON GRACE (PT, DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:ASHTON
Middle Name:GRACE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CIRCLE 75 PKWY SE STE 1400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3067
Mailing Address - Country:US
Mailing Address - Phone:678-981-3543
Mailing Address - Fax:404-777-1311
Practice Address - Street 1:3135 PEOPLES ST STE 404
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4138
Practice Address - Country:US
Practice Address - Phone:423-454-1006
Practice Address - Fax:423-328-7825
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12903OtherMEDRISK
TN12903Medicaid
TN12903OtherTRI-CARE
TN12903OtherCOMMERCIAL
TN12903OtherMEDICARE REPLACEMENT
TN12903OtherTRIWEST
TN12903OtherWORKER'S COMPENSATION