Healthcare Provider Details

I. General information

NPI: 1922769926
Provider Name (Legal Business Name): BRIANIA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 N KANITA CV
MEMPHIS TN
38125-3329
US

IV. Provider business mailing address

4425 N KANITA CV
MEMPHIS TN
38125-3329
US

V. Phone/Fax

Practice location:
  • Phone: 901-379-7396
  • Fax:
Mailing address:
  • Phone: 901-379-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: