Provider Demographics
NPI:1235814997
Name:JOHNSON, KEITH (PSS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-7909
Mailing Address - Country:US
Mailing Address - Phone:202-667-8831
Mailing Address - Fax:
Practice Address - Street 1:2523 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7909
Practice Address - Country:US
Practice Address - Phone:202-667-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist