Healthcare Provider Details

I. General information

NPI: 1124991005
Provider Name (Legal Business Name): MR. TERRY L JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MUIRFIELD DR SE
WARREN OH
44484-5604
US

IV. Provider business mailing address

95 MUIRFIELD DR SE
WARREN OH
44484-5604
US

V. Phone/Fax

Practice location:
  • Phone: 330-979-3324
  • Fax:
Mailing address:
  • Phone: 330-979-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: