Provider Demographics
NPI:1295121036
Name:JOHNS, GLORIA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ANN
Last Name:JOHNS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ANN
Other - Last Name:BENESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2520 COLUMBUS AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5547
Mailing Address - Country:US
Mailing Address - Phone:567-867-2520
Mailing Address - Fax:419-626-5640
Practice Address - Street 1:2520 COLUMBUS AVE STE F
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5547
Practice Address - Country:US
Practice Address - Phone:567-867-2520
Practice Address - Fax:419-626-5640
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215704Medicaid