Individual
IMANI JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 GROVE AVE, SHADY SIDE, MD 20764-9536
(323) 629-5749
Mailing address
1200 GROVE AVE, SHADY SIDE, MD 20764-9536
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/06/2025
Last updated
02/06/2025
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