Healthcare Provider Details

I. General information

NPI: 1922016633
Provider Name (Legal Business Name): LAURA M JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 N OKATIE HWY
RIDGELAND SC
29936-8276
US

IV. Provider business mailing address

721 N OKATIE HWY
RIDGELAND SC
29936-8276
US

V. Phone/Fax

Practice location:
  • Phone: 843-987-7400
  • Fax: 843-987-0197
Mailing address:
  • Phone: 843-987-7400
  • Fax: 843-987-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number66713
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: