Provider Demographics
NPI:1215767678
Name:JOHNSON, ANTHONY JR (PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 S EVANS AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2503
Mailing Address - Country:US
Mailing Address - Phone:312-868-6137
Mailing Address - Fax:
Practice Address - Street 1:10 S RIVERSIDE PLZ
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3728
Practice Address - Country:US
Practice Address - Phone:833-427-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker