Provider Demographics
NPI:1538393137
Name:JAMELARIN, JAHANNAH H (MD)
Entity type:Individual
Prefix:
First Name:JAHANNAH
Middle Name:H
Last Name:JAMELARIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 UPHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1104 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2353
Practice Address - Country:US
Practice Address - Phone:580-226-0543
Practice Address - Fax:580-226-2284
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11072037-12052084P0800X
CODR.00616032084P0800X
AZ577632084P0800X
ARE-119722084P0800X
TN587522084P0800X
MN650022084P0800X
OH35.1202012084P0800X
OK318322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200616890AMedicaid