Provider Demographics
NPI:1285206920
Name:JOHNSON, IZAIAH JAMAR
Entity Type:Individual
Prefix:
First Name:IZAIAH
Middle Name:JAMAR
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 1:5605 VIEW POINTE DRIVE
Mailing Address - Street 2:APT E
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213
Mailing Address - Country:US
Mailing Address - Phone:513-252-3687
Mailing Address - Fax:
Practice Address - Street 1:5605 VIEW POINTE DRIVE
Practice Address - Street 2:APT E
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213
Practice Address - Country:US
Practice Address - Phone:513-252-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No174200000XOther Service ProvidersMeals
No172A00000XOther Service ProvidersDriver