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NPI Code Detail

MEDICARE: VISTINA METTS JOHNSON

MEDICARE: VISTINA METTS 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
1363LA2100XAcute Care Nurse Practitioner23734SC

General Provider Information

NPI Number : 1407484041
Entity Type Code : Individual
Provider Name (Legal Business Name) : VISTINA METTS JOHNSON
Provider Business Mailing Address
First Line : PO BOX 743904
Second Line :
City : ATLANTA
State : GA
Zip : 30374-3904
Country : US
Telephone Number : 803-296-7320
Fax Number : 803-296-7330
Provider Business Practice Location Address
First Line : 3 RICHLAND MEDICAL PARK DR STE 510
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-6854
Country : US
Telephone Number : 803-296-2726
Fax Number : 803-296-3319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2020
Last Update Date : 02/17/2026

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Directions to “ VISTINA METTS JOHNSON ” Practice Location

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