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NPI Code Detail

MEDICARE: PHILIP GAYLES JOHNSON

MEDICARE: PHILIP GAYLES JOHNSON
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
1104100000XSocial Worker253749KY

General Provider Information

NPI Number : 1285198176
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP GAYLES JOHNSON
Provider Business Mailing Address
First Line : 1044 ALTA VISTA RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-1758
Country : US
Telephone Number : 502-377-4999
Fax Number :
Provider Business Practice Location Address
First Line : 1044 ALTA VISTA RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-1758
Country : US
Telephone Number : 502-377-4999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2019
Last Update Date : 01/25/2019

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Directions to “ PHILIP GAYLES JOHNSON ” Practice Location

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