MEDICARE: JAHZARA JOSEPHINE 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1730901612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAHZARA JOSEPHINE JOHNSON

Provider Business Mailing Address
First Line	:	PO BOX 24237
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-0237
Country	:	US
Telephone Number	:	937-470-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 ORCHARD RUN RD
Second Line	:	PMB 114
City	:	DAYTON
State	:	OH
Zip	:	45449-2831
Country	:	US
Telephone Number	:	937-952-9985
Fax Number	:	937-932-2720

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

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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