Healthcare Provider Details

I. General information

NPI: 1679419923
Provider Name (Legal Business Name): COURTNEY AHMED DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4457 STATE ROUTE 159 STE A
CHILLICOTHEE OH
45601-8620
US

IV. Provider business mailing address

131 E MAIN ST APT A
CHILLICOTHEE OH
45601-0068
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4900
  • Fax: 740-779-4909
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58.035735
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: