MEDICARE: SHEDRA 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	1041C0700X	Clinical Social Worker	C7887	MS

General Provider Information

NPI Number	:	1649716762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEDRA JOHNSON

Provider Business Mailing Address
First Line	:	904 DESOTO ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3737
Country	:	US
Telephone Number	:	228-872-8429
Fax Number	:	228-872-0226

Provider Business Practice Location Address
First Line	:	904 DESOTO ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3737
Country	:	US
Telephone Number	:	228-872-8429
Fax Number	:	228-872-0226

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

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	09/02/2022

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