Provider Demographics
NPI:1932817202
Name:ANDERSON, JUSTUS JAMES
Entity Type:Individual
Prefix:
First Name:JUSTUS
Middle Name:JAMES
Last Name:ANDERSON
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 1:47772 W HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-9438
Mailing Address - Country:US
Mailing Address - Phone:440-370-1924
Mailing Address - Fax:
Practice Address - Street 1:47772 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-9438
Practice Address - Country:US
Practice Address - Phone:440-370-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant