Healthcare Provider Details

I. General information

NPI: 1912828559
Provider Name (Legal Business Name): EDWARD DUNAWAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

2064 TUPSFIELD RD
COLUMBUS OH
43229-3816
US

V. Phone/Fax

Practice location:
  • Phone: 614-323-6134
  • Fax:
Mailing address:
  • Phone: 614-323-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberD45526885
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: