Provider Demographics
NPI:1639666159
Name:WILLIAMS-JOHNSON, BRANDIN A (AT, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRANDIN
Middle Name:A
Last Name:WILLIAMS-JOHNSON
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4402
Mailing Address - Country:US
Mailing Address - Phone:513-257-5729
Mailing Address - Fax:
Practice Address - Street 1:2800 WINSLOW AVE # MLC10001
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1144
Practice Address - Country:US
Practice Address - Phone:513-257-5729
Practice Address - Fax:513-636-6374
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0056542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherSELF