Healthcare Provider Details

I. General information

NPI: 1457580573
Provider Name (Legal Business Name): MRS. GERI LYNN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST SUITE 6253
DAYTON OH
45409-2939
US

IV. Provider business mailing address

6901 FARMERSVILLE GERMANTN PIKE
GERMANTOWN OH
45327-9588
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4812
  • Fax: 937-208-2577
Mailing address:
  • Phone: 937-855-3637
  • Fax: 937-208-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number83898
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: