Provider Demographics
NPI:1336790351
Name:EDWARDS, JAHMAL AMIRR
Entity Type:Individual
Prefix:
First Name:JAHMAL
Middle Name:AMIRR
Last Name:EDWARDS
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 1:11509 SAYWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3824
Mailing Address - Country:US
Mailing Address - Phone:216-338-8028
Mailing Address - Fax:
Practice Address - Street 1:2490 LEE BLVD STE 219
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1269
Practice Address - Country:US
Practice Address - Phone:216-338-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator