Individual
SELLITTIA RENAE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
211 B WAYNE STREET, COLUMBIA, TN 38401
(931) 560-3075
Mailing address
827 EAST GRIGSBY STREET, PULASKI, TN 38478
(931) 292-8124
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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