Individual
LATAURIS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
405 BRIARWOOD DR, JACKSON, MS 39206-3052
(601) 345-1780
(601) 510-9134
Mailing address
89 NATE RD, LAKE, MS 39092-3502
(601) 717-3244
(601) 510-9134
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
11/24/2021
Last updated
11/24/2021
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