MEDICARE: ALICIA 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
1	376K00000X	Nurse's Aide	170884	SC

General Provider Information

NPI Number	:	1346982949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA JOHNSON

Provider Business Mailing Address
First Line	:	2410 ROBIN CREST DR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-5439
Country	:	US
Telephone Number	:	803-800-7282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 ROBIN CREST DR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-5439
Country	:	US
Telephone Number	:	803-800-7282
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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Directions to “ ALICIA JOHNSON ” Practice Location

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