Individual
MRS. SHANTA MARIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCMA
Contact information
Practice address
113 22ND AVENUE SW, CENTERPOINT, AL 35215
(850) 737-7392
Mailing address
113 22ND AVE NE, CENTER POINT, AL 35215-4607
(850) 737-7392
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
18023894
AL
374U00000X
Home Health Aide
000000000
AL
374U00000X
Home Health Aide
18023894
AL
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
824882016
—
AL
Enumeration date
05/29/2018
Last updated
04/30/2024
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