Provider Demographics
NPI:1457580573
Name:JOHNSON, GERI LYNN
Entity type:Individual
Prefix:MRS
First Name:GERI
Middle Name:LYNN
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 1:6901 FARMERSVILLE GERMANTN PIKE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-9588
Mailing Address - Country:US
Mailing Address - Phone:937-855-3637
Mailing Address - Fax:937-208-2577
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 6253
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-4812
Practice Address - Fax:937-208-2577
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH83898246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
83898OtherNATIONAL CERTIFIED SURGICAL TECHNOLOGIST/FIRST ASSIST