Healthcare Provider Details

I. General information

NPI: 1336366228
Provider Name (Legal Business Name): TAWANA JOHNSON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BATTLEGROUND AVE SUITE 150A
GREENSBORO NC
27408-8042
US

IV. Provider business mailing address

PO BOX 1915
GREENSBORO NC
27402-1915
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-1339
  • Fax: 336-510-8605
Mailing address:
  • Phone: 336-272-1339
  • Fax: 336-510-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3061
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: