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General NPI Number Information
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NPI Number | 1518009547
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Entity Type | Individual
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Provider Name | BRUCE JOHNSON CMSW
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7410 MEMPHIS ARLINGTON RD
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City | BARTLETT
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State | TN
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Zip | 38135-1908
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Country | US
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Telephone | 901-252-7850
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Fax | 901-252-7880
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Provider Business Mailing Address
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Address Line | 8170 LEIGHTON LN
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City | MILLINGTON
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State | TN
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Zip | 38053-5708
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Country | US
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Telephone | 901-829-2328
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Fax | 901-829-2328
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4784
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License Number State | TN
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