Provider Demographics
NPI:1356839385
Name:JOHNSON, ALEX JEROME
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:JEROME
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 1:3690 HAYES ST NE APT T3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7541
Mailing Address - Country:US
Mailing Address - Phone:202-361-9875
Mailing Address - Fax:
Practice Address - Street 1:3690 HAYES ST NE APT T3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7541
Practice Address - Country:US
Practice Address - Phone:202-361-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant