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NPI Code Detail

MEDICARE: IRIS JOHNSON

MEDICARE: IRIS JOHNSON
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
1101YA0400XAddiction (Substance Use Disorder) Counselor864SC

General Provider Information

NPI Number : 1336531771
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRIS JOHNSON
Provider Business Mailing Address
First Line : 204 GREENEEDLE RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29229-7684
Country : US
Telephone Number : 803-587-5938
Fax Number :
Provider Business Practice Location Address
First Line : 801 N PIKE W
Second Line :
City : SUMTER
State : SC
Zip : 29153-1906
Country : US
Telephone Number : 803-572-8280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2015
Last Update Date : 07/16/2025

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Directions to “ IRIS JOHNSON ” Practice Location

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