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NPI Code Detail

MEDICARE: JOSEPH JOHNSON

MEDICARE: JOSEPH 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1619347945
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH JOHNSON
Provider Business Mailing Address
First Line : 9377 DELORES DR
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-3304
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9403 MANSFIELD RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-3815
Country : US
Telephone Number : 318-861-8938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2015
Last Update Date : 06/13/2022

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