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NPI Code Detail

MEDICARE: MRS. SUSAN DAVIS JOHNSON LBA

MEDICARE: MRS. SUSAN DAVIS JOHNSON LBA
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
1103K00000XBehavior Analyst0133001627VA

General Provider Information

NPI Number : 1245863505
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN DAVIS JOHNSON LBA
Provider Business Mailing Address
First Line : 752 TRAINING CENTER RD
Second Line :
City : HILLSVILLE
State : VA
Zip : 24343-5656
Country : US
Telephone Number : 762-371-3472
Fax Number :
Provider Business Practice Location Address
First Line : 1405 S BROAD ST
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27127-2068
Country : US
Telephone Number : 855-772-8847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2020
Last Update Date : 08/11/2025

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