Healthcare Provider Details

I. General information

NPI: 1639890106
Provider Name (Legal Business Name): BRITTNEY CIARA MCCANTS-JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W EVANS ST
FLORENCE SC
29501-3406
US

IV. Provider business mailing address

408 W EVANS ST
FLORENCE SC
29501-3406
US

V. Phone/Fax

Practice location:
  • Phone: 843-621-9266
  • Fax:
Mailing address:
  • Phone: 843-621-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: