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NPI Code Detail

MEDICARE: MR. JAMES RANDALL JOHNSON LCSW

MEDICARE: MR. JAMES RANDALL JOHNSON LCSW
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
11041C0700XClinical Social WorkerLSW0000004199TN

General Provider Information

NPI Number : 1538108899
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES RANDALL JOHNSON LCSW
Provider Business Mailing Address
First Line : 2407 ALLEN FERRY RD
Second Line :
City : SMITHVILLE
State : TN
Zip : 37166-7218
Country : US
Telephone Number : 615-597-3322
Fax Number :
Provider Business Practice Location Address
First Line : 5736 MANCHESTER HWY
Second Line :
City : MORRISON
State : TN
Zip : 37357-7503
Country : US
Telephone Number : 931-815-1212
Fax Number : 931-815-1221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 07/08/2007

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