Healthcare Provider Details

I. General information

NPI: 1063414712
Provider Name (Legal Business Name): DAVID KINNAIRD JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SWEITZER ST
GREENVILLE OH
45331-1189
US

IV. Provider business mailing address

835 SWEITZER ST
GREENVILLE OH
45331-1077
US

V. Phone/Fax

Practice location:
  • Phone: 937-547-5714
  • Fax: 937-547-5792
Mailing address:
  • Phone: 937-569-5704
  • Fax: 937-547-5789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35-04-7132-J
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: