Provider Demographics
NPI:1699936377
Name:GAITAWE-JOHNSON, PRINCESS G (MD)
Entity type:Individual
Prefix:DR
First Name:PRINCESS
Middle Name:G
Last Name:GAITAWE-JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BECKETT SPRINGS 8614 SHEPHARD FARM DR.
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-714-7297
Mailing Address - Fax:513-714-7310
Practice Address - Street 1:BECKETT SPRINGS 8614 SHEPHARD FARM DR.
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-714-7297
Practice Address - Fax:513-714-7310
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-1277802084P0804X
IN01073248A2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
12619416OtherCAQH
OH0204838Medicaid
OHH505660Medicare PIN