Individual
HALEY BASS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
783 OLD HICKORY BLVD # 360, BRENTWOOD, TN 37027-4508
(629) 203-7925
Mailing address
783 OLD HICKORY BLVD # 360, BRENTWOOD, TN 37027-4508
(629) 203-7925
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
I000000022984
TN
372600000X
Adult Companion
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080424817
DRIVERS LICENSE
TN
Enumeration date
09/11/2018
Last updated
09/11/2018
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