Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35-048254 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35.048254 | OH |
N | 207V00000X | Obstetrician & Gynecologist | 35048254 | OH |
NPI | 1285669481 |
---|---|
Provider Name | Gregory G Johnson |
First Address | Akron, OH 44305-2421 |
Second Address | Akron, OH 44310-1456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 20/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0517622 | (05) | OH |
H203912 | (02) | OH |