Healthcare Provider Details

I. General information

NPI: 1851220206
Provider Name (Legal Business Name): JAMES-DOMINIQUE POLLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 E MAIN ST
COLUMBUS OH
43213-2913
US

IV. Provider business mailing address

3616 E MAIN ST
COLUMBUS OH
43213-2913
US

V. Phone/Fax

Practice location:
  • Phone: 614-697-3600
  • Fax:
Mailing address:
  • Phone: 614-697-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: