Healthcare Provider Details

I. General information

NPI: 1053931048
Provider Name (Legal Business Name): SONJA MARIE JOHNSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONJA MARIE RANKIN

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N EWING ST STE C
LANCASTER OH
43130-3383
US

IV. Provider business mailing address

131 N EWING ST STE C
LANCASTER OH
43130-3383
US

V. Phone/Fax

Practice location:
  • Phone: 740-689-6600
  • Fax:
Mailing address:
  • Phone: 812-885-3228
  • Fax: 812-885-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number02006461A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34.017315
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: