MEDICARE: MERIDETH L JOHNSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	4510-C	AR
2	104100000X	Social Worker	2676-M	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073801338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERIDETH L JOHNSON LCSW

Provider Business Mailing Address
First Line	:	PO BOX 497
Second Line	:
City	:	AUGUSTA
State	:	AR
Zip	:	72006-0497
Country	:	US
Telephone Number	:	870-347-2534
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 FALLS BLVD S
Second Line	:
City	:	WYNNE
State	:	AR
Zip	:	72396-3041
Country	:	US
Telephone Number	:	870-362-3218
Fax Number	:	870-362-3219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2011
Last Update Date	:	05/04/2026

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