Shirley Ann Johnson, OHIO LICDC-CSAND LSW

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

LICDC-CS 933508 Issued in OH

Practice address

8658 N Main St
Dayton, OH 45415-1328

Phone

(937) 701-0030

Fax

(937) 387-9043

NPI assigned

May 5, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462406400000",
    "number": "1942656244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8658 N MAIN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454151328",
            "telephone_number": "937-701-0030",
            "fax_number": "937-387-9043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8658 N MAIN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454151328",
            "telephone_number": "937-701-0030",
            "fax_number": "937-387-9043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHIRLEY",
        "middle_name": "ANN",
        "credential": "OHIO LICDC-CSAND LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-05",
        "last_updated": "2016-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "OH",
            "license": "LICDC-CS 933508",
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "OH",
            "license": "LSW S0021857",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard E. Johnson Jr.
• Samantha Johnson, CDCA/PEER SUPPORT
• Savannah Marie Johnson
• Shawanda L Johnson
• Shereca Johnson
• Stephanie Fantauzzo Johnson, OTRL
• Taiya Johnson, LVN, CDCA
• Taylor Johnson
• Thomas Johnson, D.D.S.
• Tierra Lashelle Johnson

• Addiction Medicine (Family Medicine) Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Addiction Medicine (Family Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.