Provider Demographics
NPI:1245955905
Name:DENSON, JIMMY LEE
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:LEE
Last Name:DENSON
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 1:1536 KARAHILL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2202
Mailing Address - Country:US
Mailing Address - Phone:513-498-6804
Mailing Address - Fax:
Practice Address - Street 1:800 COMPTON RD UNIT 27
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3850
Practice Address - Country:US
Practice Address - Phone:513-498-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR573286172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver