Healthcare Provider Details

I. General information

NPI: 1700813490
Provider Name (Legal Business Name): RANDY M JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST NE
BARBERTON OH
44203-3332
US

IV. Provider business mailing address

2600 SIXTH ST SW
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-4443
  • Fax: 330-493-8677
Mailing address:
  • Phone: 330-456-2695
  • Fax: 330-588-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-087639
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35087639
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: