Healthcare Provider Details

I. General information

NPI: 1922946623
Provider Name (Legal Business Name): ALYSON 740-779-4898 JOHNSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SHAWNEE LN
CHILLICOTHEE OH
45601-4145
US

IV. Provider business mailing address

455 SHAWNEE LN
CHILLICOTHEE OH
45601-4145
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4888
  • Fax: 740-779-4898
Mailing address:
  • Phone: 740-779-4888
  • Fax: 740-779-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number58.035317
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: