Individual
BAHIYA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
333 TEXAS ST STE 1300, SHREVEPORT, LA 71101-3783
(318) 618-0292
Mailing address
333 TEXAS ST STE 1300, SHREVEPORT, LA 71101-3783
(318) 618-0292
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
00290481
LA
Other
Enumeration date
01/17/2017
Last updated
01/17/2017
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