Individual
ALICE JEANETTE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0187930
BCBS
TN
05
—
1450521
—
TN
Enumeration date
01/09/2008
Last updated
01/09/2008
Update your record
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