Provider Demographics
NPI:1518530906
Name:JOHNSON, RAYMOND LERNELL
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LERNELL
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 1:2255 PAR LN APT 114
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-2935
Mailing Address - Country:US
Mailing Address - Phone:216-212-5039
Mailing Address - Fax:
Practice Address - Street 1:2255 PAR LN APT 115
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-2935
Practice Address - Country:US
Practice Address - Phone:216-212-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health