Provider Demographics
NPI:1659101541
Name:JOHNSON, DAYLIN
Entity type:Individual
Prefix:
First Name:DAYLIN
Middle Name:
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 1:165 RIDGECREST CIR APT 3
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-5203
Mailing Address - Country:US
Mailing Address - Phone:276-356-6226
Mailing Address - Fax:
Practice Address - Street 1:165 RIDGECREST CIR APT 3
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-5203
Practice Address - Country:US
Practice Address - Phone:276-356-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver