Provider Demographics
NPI:1689385122
Name:DAWSON, JOHN JELANI AMAAN (OCPSA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JELANI AMAAN
Last Name:DAWSON
Suffix:
Gender:M
Credentials:OCPSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STELLA CT
Mailing Address - Street 2:LENORA ISAACS
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1011
Mailing Address - Country:US
Mailing Address - Phone:614-252-8402
Mailing Address - Fax:614-252-7987
Practice Address - Street 1:455 E MOUND ST
Practice Address - Street 2:LENORA ISAACS
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-252-7987
Practice Address - Fax:614-252-7987
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161764405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional