Healthcare Provider Details

I. General information

NPI: 1871484063
Provider Name (Legal Business Name): MR. GREGORY K. JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 E CAMBRIDGE AVE
FRESNO CA
93703-2123
US

IV. Provider business mailing address

1616 EL PASO AVE
CLOVIS CA
93611-6602
US

V. Phone/Fax

Practice location:
  • Phone: 559-252-6844
  • Fax:
Mailing address:
  • Phone: 559-906-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: