Healthcare Provider Details

I. General information

NPI: 1083241608
Provider Name (Legal Business Name): JAMESHA FORD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 WINTON RD
CINCINNATI OH
45240-2355
US

IV. Provider business mailing address

11550 WINTON RD
CINCINNATI OH
45240-2355
US

V. Phone/Fax

Practice location:
  • Phone: 513-924-8200
  • Fax:
Mailing address:
  • Phone: 513-924-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.016594
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: