Provider Demographics
NPI:1073399879
Name:JOHNSON, GENERAL COURTNEY
Entity Type:Individual
Prefix:DR
First Name:GENERAL
Middle Name:COURTNEY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 SW BARBUR BLVD.
Mailing Address - Street 2:STE 119 - #49
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-995-7578
Mailing Address - Fax:503-914-5476
Practice Address - Street 1:2049 NW HOYT ST STE 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1260
Practice Address - Country:US
Practice Address - Phone:503-995-7578
Practice Address - Fax:503-914-5476
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach