Provider Demographics
NPI:1982964664
Name:JOHNS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JOHNS
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 1:725 BUCKLES CT N STE 100
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6884
Mailing Address - Country:US
Mailing Address - Phone:614-471-9654
Mailing Address - Fax:614-392-4586
Practice Address - Street 1:725 BUCKLES CT N STE 100
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6884
Practice Address - Country:US
Practice Address - Phone:614-471-9654
Practice Address - Fax:614-392-4586
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126770CTR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine