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General NPI Number Information
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NPI Number | 1154512036
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Entity Type | Individual
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Provider Name | JEVON JAMAHL JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 05/10/2025
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Provider Practice Location Address
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Address Line | 1878 E HATCH RD
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City | MODESTO
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State | CA
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Zip | 95351-5002
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Country | US
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Telephone | 916-825-8847
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 576649
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City | MODESTO
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State | CA
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Zip | 95357-6649
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Country | US
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Telephone | 209-845-2553
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Fax | 209-844-0334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A101110
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License Number State | CA
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