Provider Demographics
NPI:1235986811
Name:JOHNNY E FIELDS, JOHNNY E
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:E
Last Name:JOHNNY E FIELDS
Suffix:
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 1:2126 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5609
Mailing Address - Country:US
Mailing Address - Phone:937-231-0684
Mailing Address - Fax:
Practice Address - Street 1:2126 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5609
Practice Address - Country:US
Practice Address - Phone:937-231-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.002055175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist