Provider Demographics
NPI:1003556903
Name:JOHNSON, GBEMISOLA OLUWAKEMI (MD)
Entity type:Individual
Prefix:DR
First Name:GBEMISOLA
Middle Name:OLUWAKEMI
Last Name: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 1:10901 BRIGHTON BAY BLVD NE APT 10209
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3459
Mailing Address - Country:US
Mailing Address - Phone:757-714-2331
Mailing Address - Fax:727-341-4886
Practice Address - Street 1:3817 S. SPRINGFIELD AVENUE, BOLIVAR, MO 6561
Practice Address - Street 2:SUITE 140
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-422-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program