Provider Demographics
NPI:1063414712
Name:JOHNSON, DAVID KINNAIRD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KINNAIRD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:835 SWEITZER ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1077
Mailing Address - Country:US
Mailing Address - Phone:937-569-5704
Mailing Address - Fax:937-547-5789
Practice Address - Street 1:1111 SWEITZER ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1189
Practice Address - Country:US
Practice Address - Phone:937-547-5714
Practice Address - Fax:937-547-5792
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-7132-J208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0576336Medicaid
C03338Medicare UPIN
OH0615413Medicare PIN