Individual
AMELIA M JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DPO
Contact information
Practice address
25 N MAIN ST, SUITE A, SPARTA, TN 38583-2055
(931) 836-2235
(931) 836-3036
Mailing address
25 N MAIN ST, SUITE A, SPARTA, TN 38583-2055
(931) 836-2235
(931) 836-3036
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DPO1192
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4073352
BLUE CROSS BLUE SHIELD
TN
Enumeration date
11/10/2005
Last updated
07/09/2007
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