Healthcare Provider Details

I. General information

NPI: 1346050507
Provider Name (Legal Business Name): WILLIAM E JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18916 123RD PL SE
RENTON WA
98058-6682
US

IV. Provider business mailing address

18916 123RD PL SE
RENTON WA
98058-6682
US

V. Phone/Fax

Practice location:
  • Phone: 404-441-5198
  • Fax:
Mailing address:
  • Phone: 404-441-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: