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General NPI Number Information
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NPI Number | 1639520125
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Entity Type | Individual
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Provider Name | ANDREA JOHNS PT
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Gender | Female
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Dates
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Enumeration Date | 06/25/2016
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Last Update Date | 06/25/2016
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Provider Practice Location Address
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Address Line | 218 CALDWELL DR
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City | HAZLEHURST
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State | MS
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Zip | 39083-2712
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Country | US
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Telephone | 601-894-1222
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Fax | 601-894-1315
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Provider Business Mailing Address
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Address Line | 218 CALDWELL DR
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City | HAZLEHURST
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State | MS
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Zip | 39083-2712
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Country | US
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Telephone | 601-894-1222
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Fax | 601-894-1315
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PT217802
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License Number State | MS
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