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NPI Code Detail

MEDICARE: MRS. JULIA B JOHNSON LCSW

MEDICARE: MRS. JULIA B 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
1104100000XSocial WorkerLSW0000000450TN
21041C0700XClinical Social WorkerLSW0000000450TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14026792OTHERTNTN BLUE CROSS BLUE SHIELD
22002938OTHERTNCIGNA

General Provider Information

NPI Number : 1679574602
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIA B JOHNSON LCSW
Provider Business Mailing Address
First Line : 3950 CENTRAL AVENUE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-7602
Country : US
Telephone Number : 901-458-6291
Fax Number : 901-323-4848
Provider Business Practice Location Address
First Line : 3950 CENTRAL AVENUE
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-7602
Country : US
Telephone Number : 901-458-6291
Fax Number : 901-323-4848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 02/04/2008

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