Healthcare Provider Details

I. General information

NPI: 1306000971
Provider Name (Legal Business Name): DIANE GAIL JOHNSON MT (ASCP)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANE JOHNSON HOPE MT (ASCP)

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N CENTER ST LABORATORY
HICKORY NC
28601-5046
US

IV. Provider business mailing address

420 N CENTER ST LABORATORY
HICKORY NC
28601-5046
US

V. Phone/Fax

Practice location:
  • Phone: 828-315-3769
  • Fax:
Mailing address:
  • Phone: 828-315-3769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberMT01435652
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: