MEDICARE: JOHNNIE 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1215722582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNIE JOHNSON

Provider Business Mailing Address
First Line	:	3818 HERRON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-2331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1643
Country	:	US
Telephone Number	:	513-497-1527
Fax Number	:

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

Provider Enumeration Date	:	04/09/2025
Last Update Date	:	04/09/2025

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Directions to “ JOHNNIE JOHNSON ” Practice Location

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