Provider Demographics
NPI:1932657434
Name:JOHNSON, LOUIS SHARALS III
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:SHARALS
Last Name:JOHNSON
Suffix:III
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 1:3902 GREAT SOUTHERN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4002
Mailing Address - Country:US
Mailing Address - Phone:614-402-6029
Mailing Address - Fax:
Practice Address - Street 1:3902 GREAT SOUTHERN CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4002
Practice Address - Country:US
Practice Address - Phone:614-402-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health