Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1437 | ME |
N | 207Q00000X | Family Doctor | 1437 | ME |
NPI | 1518929538 |
---|---|
Provider Name | Kenneth H Johnson |
First Address | Athens, OH 45701-2907 |
Second Address | Athens, OH 45701-2907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 20/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010211810001 | TRICARE (01) | ME |
212530099 | (05) | ME |
G16868 | (02) | ME |
MM6129 | (02) | ME |