Provider Demographics
NPI:1891261418
Name:JOHNSON, LUCRETIA ALEATHER
Entity Type:Individual
Prefix:MRS
First Name:LUCRETIA
Middle Name:ALEATHER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6306 ARMOR DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3414
Mailing Address - Country:US
Mailing Address - Phone:202-390-2154
Mailing Address - Fax:
Practice Address - Street 1:6451 ALEXANDER FERRY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3414
Practice Address - Country:US
Practice Address - Phone:202-390-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty