MEDICARE: AMY JOHNSON RDH

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	124Q00000X	Dental Hygienist	3693	TN

General Provider Information

NPI Number	:	1396346052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JOHNSON RDH

Provider Business Mailing Address
First Line	:	745 BLUE HERON PT
Second Line	:
City	:	COUNCE
State	:	TN
Zip	:	38326-4320
Country	:	US
Telephone Number	:	731-607-4140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 FLORENCE RD
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-5205
Country	:	US
Telephone Number	:	731-925-5346
Fax Number	:

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

Provider Enumeration Date	:	11/07/2020
Last Update Date	:	11/07/2020

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