Healthcare Provider Details

I. General information

NPI: 1427965490
Provider Name (Legal Business Name): VERTISHA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S PEAR ORCHARD RD STE 32
RIDGELAND MS
39157-4841
US

IV. Provider business mailing address

630 JOHN DAY RD
CANTON MS
39046-9186
US

V. Phone/Fax

Practice location:
  • Phone: 601-524-8444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3991
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: