Provider Demographics
NPI:1245731264
Name:MOXLEY, JAMAL
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:
Last Name:MOXLEY
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 1:5900 SHARON WOODS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2600
Mailing Address - Country:US
Mailing Address - Phone:614-309-3321
Mailing Address - Fax:
Practice Address - Street 1:5900 SHARON WOODS BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2600
Practice Address - Country:US
Practice Address - Phone:614-309-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator