Individual
RICHARD MATTHEW JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SERVICE COORDINATOR
Contact information
Practice address
380 SUWANNEE TRAIL STREET, BOWLING GREEN, KY 42103
(270) 901-5000
(270) 782-5927
Mailing address
384 PASCOE BLVD, BOWLING GREEN, KY 42104-5442
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
Enumeration date
10/17/2007
Last updated
04/17/2008
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