Provider Demographics
NPI:1134680424
Name:JOHNSON, MERISSA M (DO)
Entity Type:Individual
Prefix:DR
First Name:MERISSA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N LIMESTONE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1114
Mailing Address - Country:US
Mailing Address - Phone:937-523-9070
Mailing Address - Fax:937-523-9089
Practice Address - Street 1:2600 N LIMESTONE ST STE 125
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1114
Practice Address - Country:US
Practice Address - Phone:937-523-9070
Practice Address - Fax:937-523-9089
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.0165392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program