MEDICARE: PARIS JOHNAE MILTON

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	1710I1003X	Independent Duty Medical Technicians		FL

General Provider Information

NPI Number	:	1144723321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARIS JOHNAE MILTON

Provider Business Mailing Address
First Line	:	401 PARKLAN DR
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-3745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 MAGNOLIA CIR # 5612
Second Line	:
City	:	TYNDALL AFB
State	:	FL
Zip	:	32403-5604
Country	:	US
Telephone Number	:	850-283-7318
Fax Number	:

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

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	09/29/2020

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