Provider Demographics
NPI:1063815660
Name:DAILEY, JAMILA
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:
Last Name:DAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 LAKESIDE ST N APT I
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4387
Mailing Address - Country:US
Mailing Address - Phone:614-572-9664
Mailing Address - Fax:
Practice Address - Street 1:4530 LAKESIDE ST N APT I
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4387
Practice Address - Country:US
Practice Address - Phone:614-572-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-27
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0088674171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH108205214199OtherAETNA