Individual
TEARA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
791 MAGELLAN DR, FAYETTEVILLE, NC 28311-2014
(910) 568-8168
(910) 623-2119
Mailing address
791 MAGELLAN DR, FAYETTEVILLE, NC 28311-2014
(910) 910-5688
(910) 623-2119
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
66601888
—
NC
Enumeration date
03/17/2015
Last updated
06/02/2016
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