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NPI Code Detail

MEDICARE: DR. HEATHER A JOHNSON DOM

MEDICARE:  DR. HEATHER A JOHNSON  DOM
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
1171100000XAcupuncturistAP2798FL

General Provider Information

NPI Number : 1548734189
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEATHER A JOHNSON DOM
Provider Business Mailing Address
First Line : 21758 US HIGHWAY 331 N
Second Line :
City : LAUREL HILL
State : FL
Zip : 32567-3747
Country : US
Telephone Number : 850-603-9466
Fax Number : 850-834-3110
Provider Business Practice Location Address
First Line : 22395 US HIGHWAY 331 N
Second Line :
City : LAUREL HILL
State : FL
Zip : 32567-3309
Country : US
Telephone Number : 850-603-9000
Fax Number : 888-347-5228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2019
Last Update Date : 11/15/2019

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Directions to “ DR. HEATHER A JOHNSON DOM” Practice Location

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