Healthcare Provider Details

I. General information

NPI: 1790693323
Provider Name (Legal Business Name): MICHAEL TERRELL JOHNSON SR. PRSIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 E MATTHEWS AVE
JONESBORO AR
72401-3048
US

IV. Provider business mailing address

818 E MATTHEWS AVE
JONESBORO AR
72401-3048
US

V. Phone/Fax

Practice location:
  • Phone: 870-218-1722
  • Fax: 501-712-3898
Mailing address:
  • Phone: 870-218-1722
  • Fax: 501-712-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: