Provider Demographics
NPI:1750053252
Name:THORNTON, AHMAD
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:THORNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 MAYBANK CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1735
Mailing Address - Country:US
Mailing Address - Phone:614-886-2559
Mailing Address - Fax:
Practice Address - Street 1:269 MAYBANK CT
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1735
Practice Address - Country:US
Practice Address - Phone:614-886-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171WH0202X, 172A00000X, 372600000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome Modifications
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult Companion