1689385122 NPI number — JOHN JELANI AMAAN DAWSON OCPSA

Table of content: JOHN JELANI AMAAN DAWSON OCPSA (NPI 1689385122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689385122 NPI number — JOHN JELANI AMAAN DAWSON OCPSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWSON
Provider First Name:
JOHN
Provider Middle Name:
JELANI AMAAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OCPSA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689385122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 STELLA CT
Provider Second Line Business Mailing Address:
LENORA ISAACS
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43215-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-252-8402
Provider Business Mailing Address Fax Number:
614-252-7987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 E MOUND ST
Provider Second Line Business Practice Location Address:
LENORA ISAACS
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-252-7987
Provider Business Practice Location Address Fax Number:
614-252-7987
Provider Enumeration Date:
12/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 405300000X , with the licence number:  161764 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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