Provider Demographics
NPI:1144594813
Name:JOHNSON J THOTTAM MD INC.
Entity Type:Organization
Organization Name:JOHNSON J THOTTAM MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:THOTTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-492-8521
Mailing Address - Street 1:4800 HIGBEE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2528
Mailing Address - Country:US
Mailing Address - Phone:330-492-8521
Mailing Address - Fax:330-492-1967
Practice Address - Street 1:4800 HIGBEE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2528
Practice Address - Country:US
Practice Address - Phone:330-492-8521
Practice Address - Fax:330-492-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH037564261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty