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General NPI Number Information
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NPI Number | 1629972252
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Entity Type | Individual
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Provider Name | SHANTRICE JOHNSON CSFA
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Gender | Female
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 1000 MEDICAL CENTER DR
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City | HARDEEVILLE
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State | SC
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Zip | 29927-3446
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Country | US
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Telephone | 843-784-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 680 OLD OLIVE BRANCH RD
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City | ELLABELL
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State | GA
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Zip | 31308-4845
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Country | US
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Telephone | 912-856-6833
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 184502
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License Number State | GA
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