Healthcare Provider Details

I. General information

NPI: 1841027232
Provider Name (Legal Business Name): WWJ CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18711 W TEN MILE ROAD SUITE 110
SOUTHFIELD MI
48075-2633
US

IV. Provider business mailing address

18711 W TEN MILE ROAD SUITE 110
SOUTHFIELD MI
48075-2633
US

V. Phone/Fax

Practice location:
  • Phone: 313-633-5090
  • Fax: 248-395-3702
Mailing address:
  • Phone: 313-633-5090
  • Fax: 248-395-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: WESLEY W JOHNSON
Title or Position: CEO
Credential:
Phone: 313-633-5090