Healthcare Provider Details

I. General information

NPI: 1649099763
Provider Name (Legal Business Name): JAVONTAY DENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 REFUGEE RD APT 1E
COLUMBUS OH
43232-5759
US

IV. Provider business mailing address

4651 REFUGEE RD APT 1E
COLUMBUS OH
43232-5759
US

V. Phone/Fax

Practice location:
  • Phone: 380-258-5489
  • Fax: 614-427-0523
Mailing address:
  • Phone: 614-595-7246
  • Fax: 614-427-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: