MEDICARE: MS. TAMMY R 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1801047782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY R JOHNSON

Provider Business Mailing Address
First Line	:	790 ROBERTS DRIVE
Second Line	:
City	:	MONTICELLO
State	:	AR
Zip	:	71655
Country	:	US
Telephone Number	:	870-367-9732
Fax Number	:	870-460-6133

Provider Business Practice Location Address
First Line	:	3410 HWY 65 NORTH
Second Line	:
City	:	MCGEHEE
State	:	AR
Zip	:	71654
Country	:	US
Telephone Number	:	870-222-3107
Fax Number	:	870-222-6741

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

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	10/09/2008

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