Provider Demographics
NPI:1821989989
Name:EZELL, JAMAINE J SR
Entity type:Individual
Prefix:MR
First Name:JAMAINE
Middle Name:J
Last Name:EZELL
Suffix:SR
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MAYFAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2210
Mailing Address - Country:US
Mailing Address - Phone:614-390-1274
Mailing Address - Fax:
Practice Address - Street 1:256 MAYFAIR BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2210
Practice Address - Country:US
Practice Address - Phone:614-390-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver