MEDICARE: AUNDREA 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	174400000X	Specialist

General Provider Information

NPI Number	:	1871202283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUNDREA JOHNSON

Provider Business Mailing Address
First Line	:	2933 MICHIGAN AVENUE RD NE APT 1
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-5484
Country	:	US
Telephone Number	:	423-310-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 MICHIGAN AVENUE RD NE APT 1
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-5484
Country	:	US
Telephone Number	:	423-310-1240
Fax Number	:

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

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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Directions to “ AUNDREA JOHNSON ” Practice Location

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