MEDICARE: TIARA CANDICE 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	3747P1801X	Personal Care Attendant		DC
2	3747P1801X	Personal Care Attendant	110023	DC
3	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00000000	OTHER	DC	N/A

General Provider Information

NPI Number	:	1386278067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIARA CANDICE JOHNSON

Provider Business Mailing Address
First Line	:	1422 1ST ST SW APT 22
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20024-3508
Country	:	US
Telephone Number	:	202-222-5017
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 XENIA ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-3971
Country	:	US
Telephone Number	:	202-222-5017
Fax Number	:

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

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	03/03/2020

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Directions to “ TIARA CANDICE JOHNSON ” Practice Location

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