Provider Demographics
NPI:1184302200
Name:JOHNSON, JAMARION J
Entity type:Individual
Prefix:
First Name:JAMARION
Middle Name:J
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 1:6 CARDINAL WAY
Mailing Address - Street 2:UNIT 900
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63102-3979
Mailing Address - Country:US
Mailing Address - Phone:314-665-8522
Mailing Address - Fax:
Practice Address - Street 1:6 CARDINAL WAY
Practice Address - Street 2:UNIT 900
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63102
Practice Address - Country:US
Practice Address - Phone:314-665-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)