Individual
ANTOINE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
846 N 63RD ST, PHILADELPHIA, PA 19151-3443
(121) 538-8533
Mailing address
846 N 63RD ST, PHILADELPHIA, PA 19151-3443
(121) 538-8533
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
852373
PA
Other
Enumeration date
10/13/2020
Last updated
10/16/2020
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