Individual
ALICIA RENEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
98 STATE ST, PROCTORVILLE, OH 45669-8163
(740) 886-9370
(740) 886-9374
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 886-9370
(740) 886-9374
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.003097RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0095884
—
OH
01
—
P00914836
RR MEDICARE
OH
Enumeration date
08/18/2010
Last updated
01/21/2021
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