MEDICARE: LISA MARIE JOHNSON LM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	LMW-0043	SC

General Provider Information

NPI Number	:	1083944946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE JOHNSON LM

Provider Business Mailing Address
First Line	:	2764 PLEASANT RD # 10748
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7213
Country	:	US
Telephone Number	:	704-900-9849
Fax Number	:	704-947-9076

Provider Business Practice Location Address
First Line	:	3113 HIGHGATE DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-7304
Country	:	US
Telephone Number	:	704-900-9849
Fax Number	:	704-947-9076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	05/15/2024

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Directions to “ LISA MARIE JOHNSON LM” Practice Location

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