Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | E-0003133 | OH |
NPI | 1003828385 |
---|---|
Provider Name | James Johnson |
First Address | Georgetown, OH 45121-1460 |
Second Address | Georgetown, OH 45121-1460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 08/07/2007 |