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General NPI Number Information
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NPI Number | 1952916231
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Entity Type | Individual
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Provider Name | CHADRIKA L JOHNSON OWNER, CENTER DIRECT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2020
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Last Update Date | 09/13/2020
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Provider Practice Location Address
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Address Line | 1800 ALBANY ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-5901
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Country | US
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Telephone | 912-571-7497
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Fax |
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Provider Business Mailing Address
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Address Line | 139 ALTAMA CONNECTOR UNIT 181
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City | BRUNSWICK
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State | GA
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Zip | 31525-1888
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Country | US
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Telephone | 912-571-7497
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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 | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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