Healthcare Provider Details

I. General information

NPI: 1144698895
Provider Name (Legal Business Name): AARON JOSEPH JOLLIFF PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR EMERGENCY DEPARTMENT
SPRINGFIELD OH
45504-2687
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-1461
  • Fax:
Mailing address:
  • Phone: 800-828-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.004449
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: