Healthcare Provider Details

I. General information

NPI: 1891688644
Provider Name (Legal Business Name): JAMMIE JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 BIENVILLE ST
NEW ORLEANS LA
70119-5151
US

IV. Provider business mailing address

3909 BIENVILLE ST
NEW ORLEANS LA
70119-5151
US

V. Phone/Fax

Practice location:
  • Phone: 504-353-6248
  • Fax:
Mailing address:
  • Phone: 504-353-6248
  • Fax: 504-353-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: