MEDICARE: GENEA ZECOLE JOHNSON L.AC, LMT

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	225700000X	Massage Therapist	8989	SC
2	171100000X	Acupuncturist	390	SC

General Provider Information

NPI Number	:	1700583952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEA ZECOLE JOHNSON L.AC, LMT

Provider Business Mailing Address
First Line	:	3710 LANDMARK DR STE 200
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4034
Country	:	US
Telephone Number	:	803-446-5117
Fax Number	:	803-227-2434

Provider Business Practice Location Address
First Line	:	3710 LANDMARK DR STE 200
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4034
Country	:	US
Telephone Number	:	803-961-2288
Fax Number	:	803-227-2434

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

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	01/31/2026

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