Provider Demographics
NPI:1194245944
Name:KAJA-WILLIAMS, TABITHA R
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:R
Last Name:KAJA-WILLIAMS
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 1:4478 CHESWICK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6004
Mailing Address - Country:US
Mailing Address - Phone:815-549-5881
Mailing Address - Fax:
Practice Address - Street 1:1769 E KENWORTH RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4363
Practice Address - Country:US
Practice Address - Phone:815-549-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0202667376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020266789Medicaid