MEDICARE: GEORGE R JEWELL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	6364	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205027612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE R JEWELL PHD

Provider Business Mailing Address
First Line	:	4805 MONTGOMERY RD STE 150
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2280
Country	:	US
Telephone Number	:	513-936-5358
Fax Number	:	513-961-1912

Provider Business Practice Location Address
First Line	:	8075 WASHINGTON VILLAGE DR STE 1
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1847
Country	:	US
Telephone Number	:	513-241-2370
Fax Number	:	513-241-6053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	11/14/2024

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