MEDICARE: HOPE 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	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	914342290	OTHER	AR	DRIVERS LICENSE

General Provider Information

NPI Number	:	1508596917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOPE JOHNSON

Provider Business Mailing Address
First Line	:	226 MCCORD HALL
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38152-3330
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 MADISON ST APT B
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-1995
Country	:	US
Telephone Number	:	501-749-4691
Fax Number	:

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

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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Directions to “ HOPE JOHNSON ” Practice Location

Language	Start Address	Practice Location

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