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General NPI Number Information
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NPI Number | 1477448249
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Entity Type | Organization
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Legal Business Name | JOHNSON DIAGNOSTIC LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 121 FRONT STREET
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City | PURVIS
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State | MS
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Zip | 39475
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Country | US
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Telephone | 833-385-3874
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Fax | 601-861-4433
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Provider Business Mailing Address
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Address Line | 121 FRONT STREET
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City | PURVIS
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State | MS
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Zip | 39475
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Country | US
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Telephone | 833-385-3874
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Fax | 601-861-4433
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Authorized Official
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Title or Position | CEO
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Name | WANKETHIA JOHNSON
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Credential |
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Telephone | 833-385-3874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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