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NPI Code Detail

MEDICARE: DELBRA RENEE JOHNSON

MEDICARE: DELBRA RENEE 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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1841706025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELBRA RENEE JOHNSON
Provider Business Mailing Address
First Line : 4067 STEAM MILL RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-4819
Country : US
Telephone Number : 762-821-3112
Fax Number : 762-821-3113
Provider Business Practice Location Address
First Line : 4067 STEAM MILL RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31907-4819
Country : US
Telephone Number : 762-821-3112
Fax Number : 762-821-3113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/24/2017
Last Update Date : 12/24/2017

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Directions to “ DELBRA RENEE JOHNSON ” Practice Location

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