MEDICARE: JOHNSON ACUPUNCTURE AND ORIENTAL MEDICINE, LLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1780209379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON ACUPUNCTURE AND ORIENTAL MEDICINE, LLC

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	:

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	:	850-834-2118
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	HEATHER A JOHNSON
Credential	:	DOM
Telephone Number	:	850-603-9466

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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