Healthcare Provider Details

I. General information

NPI: 1750080164
Provider Name (Legal Business Name): JULIAN NABORS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BRYDEN RD
COLUMBUS OH
43215-4839
US

IV. Provider business mailing address

1079 FAIRWOOD AVE
COLUMBUS OH
43206-1815
US

V. Phone/Fax

Practice location:
  • Phone: 513-345-0195
  • Fax:
Mailing address:
  • Phone: 614-233-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: