Provider Demographics
NPI:1528817004
Name:SMITH-JOHNSON, CORETHA (MASTER PUBLIC HEALTH)
Entity type:Individual
Prefix:
First Name:CORETHA
Middle Name:
Last Name:SMITH-JOHNSON
Suffix:
Gender:F
Credentials:MASTER PUBLIC HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 LAWNTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-3742
Mailing Address - Country:US
Mailing Address - Phone:215-280-0867
Mailing Address - Fax:
Practice Address - Street 1:6603 SOUDER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2207
Practice Address - Country:US
Practice Address - Phone:215-280-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator