Individual
DR. CHARISSE D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
229 FLORENCE AVE STE 233, GRANGER, IN 46530-8048
(574) 855-4575
(833) 314-0410
Mailing address
229 FLORENCE AVE STE 233, GRANGER, IN 46530-8048
(574) 855-4575
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01068390A
IN
208000000X
Pediatrics Physician
4301117107
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134399025
—
MI
05
—
200987950
—
IN
Enumeration date
03/06/2008
Last updated
11/24/2025
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