Healthcare Provider Details

I. General information

NPI: 1043215304
Provider Name (Legal Business Name): RHONDA D JOHNSON M.S.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 HIGHLAND TER
MURFREESBORO TN
37130-2420
US

IV. Provider business mailing address

511 HIGHLAND TER
MURFREESBORO TN
37130-2420
US

V. Phone/Fax

Practice location:
  • Phone: 615-848-0065
  • Fax: 615-848-0862
Mailing address:
  • Phone: 615-848-0065
  • Fax: 615-848-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW0000003375
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: