Basic Information
| Provider Information | |||||||||
| NPI: | 1942265947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNS | ||||||||
| FirstName: | NATHANIEL | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1592 GRANVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431301076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406870835 | ||||||||
| FaxNumber: | 7406879391 | ||||||||
| Practice Location | |||||||||
| Address1: | 1592 GRANVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431301076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406870835 | ||||||||
| FaxNumber: | 7406879391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 02/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 35080820J | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000000222851 | 01 | OH | ANTHEM BLUE CROSS PIN | OTHER |