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General NPI Number Information
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NPI Number | 1891137873
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Entity Type | Individual
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Provider Name | BEVERLY C JOHNSON MSW
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Gender | Female
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 116 S EDWARD AVENUE
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City | MOUND BAYOU
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State | MS
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Zip | 38762
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Country | US
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Telephone | 662-719-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 114 EDWARD AVENUE SUITE B
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City | MOUND BAYOU
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State | MS
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Zip | 38762
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Country | US
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Telephone | 662-719-2005
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | MS68NHC
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License Number State | MS
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