MEDICARE: MS. HEATHER 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	1710I1002X	Independent Duty Corpsman

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1383105133	OTHER		MILITARY

General Provider Information

NPI Number	:	1902226236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER JOHNSON

Provider Business Mailing Address
First Line	:	1050 REGISTER ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-2421
Country	:	US
Telephone Number	:	843-308-9662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 REGISTER ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29405-2421
Country	:	US
Telephone Number	:	438-308-9662
Fax Number	:

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

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	09/29/2021

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