Provider Demographics
NPI:1063222651
Name:REID, JOWAYNE DA
Entity type:Individual
Prefix:
First Name:JOWAYNE
Middle Name:DA
Last Name:REID
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 1:1551 BRYDEN RD APT 233
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2199
Mailing Address - Country:US
Mailing Address - Phone:614-294-9671
Mailing Address - Fax:
Practice Address - Street 1:1551 BRYDEN RD APT 233
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2199
Practice Address - Country:US
Practice Address - Phone:614-294-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator