Geordan Legette Johnson
Psychologist in Roxbury, MA. Individual provider (NPI-1).
NPI number1194035774
StatusActive
Last updated in NPPESOct 15, 2010
Details
- NPI
- 1194035774
- Entity type
- Individual (NPI-1)
- Name
- Mr. Geordan Legette Johnson
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 15, 2010
- Last updated
- Oct 15, 2010
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | s66991897 | MA | Yes |
Practice location
504 Dudley StRoxbury, MA 02119-2732
Phone 617-445-6655
Mailing address
175 Woodrow AveDorchester Center, MA 02124-3210
Phone 617-388-8139
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