MEDICARE: EMILY 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	133V00000X	Registered Dietitian	3759	SC

General Provider Information

NPI Number	:	1629902580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JOHNSON

Provider Business Mailing Address
First Line	:	6A HOWARD ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-4921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6A HOWARD ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-4921
Country	:	US
Telephone Number	:	864-561-1162
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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