Individual
GABY LAVERNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
32 SHAW SKENE RD, SHAW, MS 38773-9502
(662) 721-6438
Mailing address
PO BOX 747, BOYLE, MS 38730-0747
(662) 721-6438
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
MS
Other
Enumeration date
10/04/2023
Last updated
10/04/2023
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