Provider Demographics
NPI:1346934957
Name:JOHNSON, SAMARRA
Entity Type:Individual
Prefix:
First Name:SAMARRA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19600 EUCLID AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1437
Mailing Address - Country:US
Mailing Address - Phone:216-288-1699
Mailing Address - Fax:
Practice Address - Street 1:19600 EUCLID AVE APT 304
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1437
Practice Address - Country:US
Practice Address - Phone:216-288-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator