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General NPI Number Information
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NPI Number | 1730072125
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Entity Type | Individual
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Provider Name | DEONTA L JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2220 LAWRENCE ST APT B1
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City | DETROIT
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State | MI
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Zip | 48206-1568
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Country | US
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Telephone | 313-551-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 15401 GILCHRIST ST
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City | DETROIT
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State | MI
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Zip | 48227-1574
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Country | US
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Telephone | 313-624-5168
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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 | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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