Individual
DR. KEONNA D'WYETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3133
(215) 707-3945
Mailing address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3133
(215) 707-3945
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD474272
PA
208600000X
Surgery Physician
U0604
TX
Other
Enumeration date
06/04/2012
Last updated
02/13/2025
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