Healthcare Provider Details

I. General information

NPI: 1295677185
Provider Name (Legal Business Name): AUSTIN FORREST JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AUSTIN JOHNSON

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N. MARIO CAPECCHI DR., HELIX 5N
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N. MARIO CAPECCHI DR., HELIX 5N
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax:
Mailing address:
  • Phone: 801-581-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: