Individual
DAVID GRANT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2131 E STATE ST, ATHENS, OH 45701-2138
(740) 589-3100
(740) 589-3123
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 589-3100
(740) 589-3123
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35.057127
OH
207Q00000X
Family Medicine Physician
12479
WV
207Q00000X
Family Medicine Physician
35.057127
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000277616
OHIO MEDICAID UNISON
OH
05
—
0049793000
—
WV
01
—
0597813
OHIO MEDICAID MOLINA
OH
05
—
0597813
—
OH
01
—
P00806992
RAILROAD MEDICARE
OH
Enumeration date
08/12/2005
Last updated
01/21/2021
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