Healthcare Provider Details

I. General information

NPI: 1609395029
Provider Name (Legal Business Name): JAMES WYATT GRIBBLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 MADISON RD FL 1
CINCINNATI OH
45227-1426
US

IV. Provider business mailing address

4760 MADISON RD FL 1
CINCINNATI OH
45227-1426
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-0035
  • Fax: 513-861-0086
Mailing address:
  • Phone: 513-861-0035
  • Fax: 513-861-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: