Organization
MARTEZ ANTONIO JOHNSON
Active
Other names
Excelcare Rehabilitation Services
Organization subpart
No
Provider details
NPI number
Authorized official
MARTEZ ANTONIO JOHNSON (OWNER)
(601) 605-2313
Entity
Organization
Contact information
Practice address
3751 BISHOP AVE, JACKSON, MS 39213-5017
(601) 605-2313
Mailing address
3751 BISHOP AVE, JACKSON, MS 39213-5017
(601) 605-2313
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLIED FOR
—
MS
Enumeration date
02/09/2009
Last updated
02/09/2009
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