Healthcare Provider Details

I. General information

NPI: 1992067011
Provider Name (Legal Business Name): HAMIDOU FOFANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 09/29/2026
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4226 SESTOS DR
COLUMBUS OH
43207-8431
US

IV. Provider business mailing address

5405 MENDON CT
COLUMBUS OH
43232-5467
US

V. Phone/Fax

Practice location:
  • Phone: 614-735-9273
  • Fax: 614-295-8462
Mailing address:
  • Phone: 614-577-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.482536
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number159087
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: