Healthcare Provider Details

I. General information

NPI: 1962325282
Provider Name (Legal Business Name): MR. HAMZA CRENSHAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 PETZINGER RD STE G
COLUMBUS OH
43209-3498
US

IV. Provider business mailing address

3314 NOE BIXBY RD
COLUMBUS OH
43232-6065
US

V. Phone/Fax

Practice location:
  • Phone: 614-372-5475
  • Fax:
Mailing address:
  • Phone: 614-586-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: