Provider Demographics
NPI:1568206563
Name:JOHNSON, PATRICK
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 DIXIE HWY STE 325
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4163
Mailing Address - Country:US
Mailing Address - Phone:615-892-2308
Mailing Address - Fax:
Practice Address - Street 1:3934 DIXIE HWY STE 325
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4163
Practice Address - Country:US
Practice Address - Phone:615-892-2308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist