Provider Demographics
NPI:1346701117
Name:JOHNSON, JOSEPH (BS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-0408
Mailing Address - Country:US
Mailing Address - Phone:580-250-1123
Mailing Address - Fax:580-248-0171
Practice Address - Street 1:307 SW C AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4016
Practice Address - Country:US
Practice Address - Phone:580-250-1123
Practice Address - Fax:580-248-0171
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator