Provider Demographics
NPI:1912138538
Name:AJWJ GROUP LLC
Entity Type:Organization
Organization Name:AJWJ GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-366-7184
Mailing Address - Street 1:1700 TEAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2095
Mailing Address - Country:US
Mailing Address - Phone:405-366-7184
Mailing Address - Fax:405-366-7184
Practice Address - Street 1:1700 TEAKWOOD CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-2095
Practice Address - Country:US
Practice Address - Phone:405-366-7184
Practice Address - Fax:405-366-7184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200208470AMedicaid
OK200256860AMedicaid