Healthcare Provider Details

I. General information

NPI: 1871685347
Provider Name (Legal Business Name): PYTHIAS DAMON JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 WARRENSVILLE CENTER RD #216
SHAKER HEIGHTS OH
44122-5247
US

IV. Provider business mailing address

3645 WARRENSVILLE CENTER RD #216
SHAKER HEIGHTS OH
44122-5247
US

V. Phone/Fax

Practice location:
  • Phone: 216-752-5020
  • Fax:
Mailing address:
  • Phone: 216-752-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberOH014733
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: