Provider Demographics
NPI:1639948284
Name:JOHNSON, NATHAN KEITH SR
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:KEITH
Last Name:JOHNSON
Suffix:SR
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 1:4889 SINCLAIR RD STE 211
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5434
Mailing Address - Country:US
Mailing Address - Phone:614-394-5882
Mailing Address - Fax:
Practice Address - Street 1:4889 SINCLAIR RD STE 211
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5434
Practice Address - Country:US
Practice Address - Phone:614-394-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
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