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General NPI Number Information
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NPI Number | 1205027612
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Entity Type | Individual
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Provider Name | GEORGE R JEWELL PHD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 8075 WASHINGTON VILLAGE DR STE 1
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City | DAYTON
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State | OH
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Zip | 45458-1847
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Country | US
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Telephone | 513-241-2370
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Fax | 513-241-6053
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Provider Business Mailing Address
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Address Line | 4805 MONTGOMERY RD STE 150
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City | CINCINNATI
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State | OH
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Zip | 45212-2280
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Country | US
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Telephone | 513-936-5358
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Fax | 513-961-1912
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6364
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License Number State | OH
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