Provider Demographics
NPI:1861032849
Name:JOHNSON, AKIRA (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:AKIRA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 BUSH RIVER RD STE 5
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5662
Mailing Address - Country:US
Mailing Address - Phone:803-312-3609
Mailing Address - Fax:
Practice Address - Street 1:2800 BUSH RIVER RD STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5662
Practice Address - Country:US
Practice Address - Phone:803-312-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program