MEDICARE: BRUCE JOHNSON CMSW

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	4784	TN

General Provider Information

NPI Number	:	1518009547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE JOHNSON CMSW

Provider Business Mailing Address
First Line	:	8170 LEIGHTON LN
Second Line	:
City	:	MILLINGTON
State	:	TN
Zip	:	38053-5708
Country	:	US
Telephone Number	:	901-829-2328
Fax Number	:	901-829-2328

Provider Business Practice Location Address
First Line	:	7410 MEMPHIS ARLINGTON RD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38135-1908
Country	:	US
Telephone Number	:	901-252-7850
Fax Number	:	901-252-7880

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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