Healthcare Provider Details

I. General information

NPI: 1073418257
Provider Name (Legal Business Name): JOHNNA STAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 DEXTER L WOODS MEMORIAL BLVD STE A
WAYNESBORO TN
38485-2460
US

IV. Provider business mailing address

211 DEXTER L WOODS MEMORIAL BLVD STE A
WAYNESBORO TN
38485-2460
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-9601
  • Fax: 931-722-9603
Mailing address:
  • Phone: 931-722-9601
  • Fax: 931-722-9603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number43270
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: