Healthcare Provider Details

I. General information

NPI: 1396190542
Provider Name (Legal Business Name): AHMED MOHAMED JAMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 W BROAD ST
COLUMBUS OH
43204-1306
US

IV. Provider business mailing address

7761 DONWICK DR
REYNOLDSBURG OH
43068-3176
US

V. Phone/Fax

Practice location:
  • Phone: 614-869-2002
  • Fax: 614-792-6240
Mailing address:
  • Phone: 614-377-9146
  • Fax: 614-792-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193464
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006591
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: