Provider Demographics
NPI:1730901612
Name:JOHNSON, JAHZARA JOSEPHINE
Entity type:Individual
Prefix:
First Name:JAHZARA
Middle Name:JOSEPHINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24237
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-0237
Mailing Address - Country:US
Mailing Address - Phone:937-470-6008
Mailing Address - Fax:
Practice Address - Street 1:2775 ORCHARD RUN RD
Practice Address - Street 2:PMB 114
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2831
Practice Address - Country:US
Practice Address - Phone:937-952-9985
Practice Address - Fax:937-932-2720
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator