Provider Demographics
NPI:1164283255
Name:JOHNSON, TAYLOR MICHAEL
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MICHAEL
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 1:3815 JOHNSON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43787-9565
Mailing Address - Country:US
Mailing Address - Phone:740-381-5976
Mailing Address - Fax:
Practice Address - Street 1:3815 JOHNSON RIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKPORT
Practice Address - State:OH
Practice Address - Zip Code:43787-9565
Practice Address - Country:US
Practice Address - Phone:740-381-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide