Provider Demographics
NPI:1770740730
Name:JOHNSON, JAMES GRAYSON III (MA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GRAYSON
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 LONGFELLOW ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1748
Mailing Address - Country:US
Mailing Address - Phone:301-565-4157
Mailing Address - Fax:
Practice Address - Street 1:4103 LONGFELLOW ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1748
Practice Address - Country:US
Practice Address - Phone:301-565-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional