Healthcare Provider Details

I. General information

NPI: 1639766025
Provider Name (Legal Business Name): MICHELLE AJAMIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 MILL CREEK RD
MILLFIELD OH
45761-9615
US

IV. Provider business mailing address

PO BOX 2322
ATHENS OH
45701-5122
US

V. Phone/Fax

Practice location:
  • Phone: 740-590-1501
  • Fax:
Mailing address:
  • Phone: 740-590-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: