Basic Information
| Provider Information | |||||||||
| NPI: | 1528091758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLAI | ||||||||
| FirstName: | ASHTON | ||||||||
| MiddleName: | VISHNU | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W PARK CIR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162011 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 W PARK CIR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368384181 | ||||||||
| FaxNumber: | 3368384185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 01/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 200000552 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.