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General NPI Number Information
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NPI Number | 1639666159
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Entity Type | Individual
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Provider Name | BRANDIN A WILLIAMS-JOHNSON AT, ATC
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Gender | Male
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 2800 WINSLOW AVE # MLC10001
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City | CINCINNATI
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State | OH
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Zip | 45206-1144
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Country | US
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Telephone | 513-257-5729
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Fax | 513-636-6374
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Provider Business Mailing Address
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Address Line | 6422 MAYFLOWER AVE
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City | CINCINNATI
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State | OH
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Zip | 45237-4402
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Country | US
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Telephone | 513-257-5729
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT005654
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License Number State | OH
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