MEDICARE: DASHON ANTANELLIA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1063123966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASHON ANTANELLIA JOHNSON

Provider Business Mailing Address
First Line	:	1355 BLACKSTONE AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-3729
Country	:	US
Telephone Number	:	256-640-2464
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 HINMAN CT
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-1438
Country	:	US
Telephone Number	:	256-640-2464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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Directions to “ DASHON ANTANELLIA JOHNSON ” Practice Location

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