Healthcare Provider Details

I. General information

NPI: 1851049746
Provider Name (Legal Business Name): MS. AVIS JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 READ BLVD
NEW ORLEANS LA
70127-3106
US

IV. Provider business mailing address

5610 READ BLVD
NEW ORLEANS LA
70127-3106
US

V. Phone/Fax

Practice location:
  • Phone: 504-241-8188
  • Fax: 504-777-3647
Mailing address:
  • Phone: 504-241-8188
  • Fax: 504-777-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC9275
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: