Provider Demographics
NPI:1073398186
Name:AXON COLUMBUS, LLC
Entity Type:Organization
Organization Name:AXON COLUMBUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JERAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-402-8992
Mailing Address - Street 1:9245 N MERIDIAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1832
Mailing Address - Country:US
Mailing Address - Phone:317-818-9000
Mailing Address - Fax:317-818-9009
Practice Address - Street 1:2675 FOX POINTE DR STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3391
Practice Address - Country:US
Practice Address - Phone:812-665-0181
Practice Address - Fax:812-605-0183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXON HEALTH ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty