Provider Demographics
NPI:1235278219
Name:JOHNSON, FELICIA ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 WHITE POND DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1115
Mailing Address - Country:US
Mailing Address - Phone:330-869-0669
Mailing Address - Fax:330-869-5769
Practice Address - Street 1:585 WHITE POND DR
Practice Address - Street 2:SUITE E
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1115
Practice Address - Country:US
Practice Address - Phone:330-869-0669
Practice Address - Fax:330-869-5769
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003438213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2769526Medicaid
OH6041300001Medicare NSC
OH2769526Medicaid