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General NPI Number Information
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NPI Number | 1760298251
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Entity Type | Individual
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Provider Name | JACK CHAMPNEY CORNELL
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Gender | Male
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1120 POLARIS PKWY STE 105A
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City | COLUMBUS
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State | OH
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Zip | 43240-4042
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Country | US
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Telephone | 614-505-0388
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Fax | 855-734-2645
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Provider Business Mailing Address
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Address Line | 15371 HEMLOCK POINT RD
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-3801
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Country | US
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Telephone | 440-223-8848
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Fax |
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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 | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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