Provider Demographics
NPI:1336933787
Name:MADISON, JOHNNA R (DPM)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:R
Last Name:MADISON
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2498
Mailing Address - Country:US
Mailing Address - Phone:330-386-2793
Mailing Address - Fax:330-386-2790
Practice Address - Street 1:425 W 5TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2498
Practice Address - Country:US
Practice Address - Phone:330-386-2793
Practice Address - Fax:330-386-2790
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program