Provider Demographics
NPI:1841843638
Name:JAH, SALAMATU
Entity type:Individual
Prefix:
First Name:SALAMATU
Middle Name:
Last Name:JAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 S HAMILTON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4300
Mailing Address - Country:US
Mailing Address - Phone:614-256-9209
Mailing Address - Fax:614-577-0767
Practice Address - Street 1:2242 S HAMILTON RD STE 202
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4300
Practice Address - Country:US
Practice Address - Phone:614-256-9209
Practice Address - Fax:614-577-0767
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-20
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000Medicaid