MEDICARE: SHATAVIER 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
1	104100000X	Social Worker		FL
2	101YM0800X	Mental Health Counselor	ISW21463	FL

General Provider Information

NPI Number	:	1871462135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATAVIER JOHNSON

Provider Business Mailing Address
First Line	:	6817 SOUTHPOINT PKWY STE 1201
Second Line	:	STE 1201
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6296
Country	:	US
Telephone Number	:	336-512-4746
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 SOUTHPOINT PKWY STE 1201
Second Line	:	STE 1201
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6296
Country	:	US
Telephone Number	:	336-512-4746
Fax Number	:

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

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	11/04/2025

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Directions to “ SHATAVIER JOHNSON ” Practice Location

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