Healthcare Provider Details

I. General information

NPI: 1063325785
Provider Name (Legal Business Name): JOSIAH JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 RANDOLPH RD
CHARLOTTE NC
28211-1318
US

IV. Provider business mailing address

300 E 36TH ST APT 537
CHARLOTTE NC
28206-2650
US

V. Phone/Fax

Practice location:
  • Phone: 704-486-2527
  • Fax:
Mailing address:
  • Phone: 864-915-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number15704
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: