Provider Demographics
NPI:1538946462
Name:JOHNSON, GEOFFREY (CAA)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15288 GOSHORN RD
Mailing Address - Street 2:
Mailing Address - City:DE MOSSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41033-9640
Mailing Address - Country:US
Mailing Address - Phone:513-505-9976
Mailing Address - Fax:
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2989
Practice Address - Country:US
Practice Address - Phone:513-585-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant