Healthcare Provider Details

I. General information

NPI: 1447308242
Provider Name (Legal Business Name): WILMA MAXINE JOHNSON SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TROOP MEDICAL CENTER CAMP CASEY
APO KOREA
96224
KR

IV. Provider business mailing address

C CO 302D BSB TMC UNIT 15609
APO KOREA
96224
KR

V. Phone/Fax

Practice location:
  • Phone: 7304308
  • Fax: 7304313
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberI9820
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: