Provider Demographics
NPI:1932888765
Name:JOHNSON, AMBULAI III
Entity type:Individual
Prefix:MR
First Name:AMBULAI
Middle Name:
Last Name:JOHNSON
Suffix:III
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 1:11721 CIDER PRESS PL
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-2712
Mailing Address - Country:US
Mailing Address - Phone:202-351-1133
Mailing Address - Fax:
Practice Address - Street 1:11721 CIDER PRESS PL
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-2712
Practice Address - Country:US
Practice Address - Phone:202-351-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker