Basic Information
Provider Information
NPI: 1801547237
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OATNEY
FirstName: JAMES
MiddleName: BENJAMIN
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7527
Address2:  
City: DUBLIN
State: OH
PostalCode: 430170727
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 111 S GRANT AVE
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432154701
CountryCode: US
TelephoneNumber: 6145668883
FaxNumber: 6145668149
Other Information
ProviderEnumerationDate: 01/18/2022
LastUpdateDate: 08/17/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/17/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X50.007410RXOHY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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