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NPI Code Detail

MEDICARE: CHARLES JOHNSON

MEDICARE: CHARLES 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) Counselor339LA

General Provider Information

NPI Number : 1942674791
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES JOHNSON
Provider Business Mailing Address
First Line : 5925 GREENWELL SPRINGS RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-1620
Country : US
Telephone Number : 225-926-7911
Fax Number : 225-926-7914
Provider Business Practice Location Address
First Line : 5925 GREENWELL SPRINGS RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-1620
Country : US
Telephone Number : 225-926-7911
Fax Number : 225-926-7914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2015
Last Update Date : 11/17/2015

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Directions to “ CHARLES JOHNSON ” Practice Location

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