| Doctor Name: | DR. KELLIE SUZANNE JOHNSON |
| NPI Number: | 1447307632 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 35063302J |
| Business Practice Address: | 2221 9th St Sw Canton, OH - 447061464 |
| Business Phone Number: | 3304553663 |
| Business Fax Number: | 3304555355 |
| Mailing Address: | 9220 Bletchley Ave Nw, NORTH CANTON |
| State: | OH |
| Postal Code: | 447204599 |
| Phone Number: | 3304975975 |
| Fax Number: | |
| NPI Enumeration Date: | 01/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 35063302J |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |