Provider Demographics
NPI:1982473070
Name:JOHNSON JR, ROY THOMAS JR
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:THOMAS
Last Name:JOHNSON JR
Suffix:JR
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 1:2180 ROMIG RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3879
Mailing Address - Country:US
Mailing Address - Phone:330-212-5731
Mailing Address - Fax:
Practice Address - Street 1:904 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-2959
Practice Address - Country:US
Practice Address - Phone:330-212-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist