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NPI Code Detail

MEDICARE: REGINA R JOHNSON BA

MEDICARE: REGINA R JOHNSON BA
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1912116609
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINA R JOHNSON BA
Provider Business Mailing Address
First Line : 4041 KNIGHT ARNOLD RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38118-2128
Country : US
Telephone Number : 901-821-5600
Fax Number : 901-821-5864
Provider Business Practice Location Address
First Line : 4041 KNIGHT ARNOLD RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38118-2128
Country : US
Telephone Number : 901-821-5600
Fax Number : 901-821-5864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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