MEDICARE: MR. GARETT JEROME JOHNSON JR.

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1205771953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARETT JEROME JOHNSON JR.

Provider Business Mailing Address
First Line	:	723 BIRCH HILL DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-3015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	723 BIRCH HILL DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-3015
Country	:	US
Telephone Number	:	330-720-7764
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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