Provider Demographics
NPI:1992953749
Name:JOHNSON, JONATHAN ASHELY COLLIS (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ASHELY COLLIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 F ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2715
Mailing Address - Country:US
Mailing Address - Phone:202-861-2971
Mailing Address - Fax:
Practice Address - Street 1:2112 F ST NW STE 804
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2760
Practice Address - Country:US
Practice Address - Phone:202-861-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071192208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery