Individual
ERIC JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
283 GRANDVIEW AVE, WADSWORTH, OH 44281-1160
(330) 391-1308
Mailing address
283 GRANDVIEW AVE, WADSWORTH, OH 44281-1160
(330) 391-1308
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
SR793116
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5213889
—
OH
Enumeration date
11/08/2020
Last updated
11/13/2020
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