Healthcare Provider Details

I. General information

NPI: 1730079518
Provider Name (Legal Business Name): SYMPHONY JOHNSON LICSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 ATKINS DR
MEMPHIS TN
38109-7103
US

IV. Provider business mailing address

5111 ATKINS DR
MEMPHIS TN
38109-7103
US

V. Phone/Fax

Practice location:
  • Phone: 901-255-4999
  • Fax:
Mailing address:
  • Phone: 901-255-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWIA.SC.70003137
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: