Provider Demographics
NPI:1225836695
Name:HORTON, JAH L III
Entity type:Individual
Prefix:MR
First Name:JAH
Middle Name:L
Last Name:HORTON
Suffix:III
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1212
Mailing Address - Country:US
Mailing Address - Phone:937-567-2981
Mailing Address - Fax:
Practice Address - Street 1:721 ELMHURST RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1212
Practice Address - Country:US
Practice Address - Phone:937-567-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT266410172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver