Provider Demographics
NPI:1285044024
Name:CRISSY M. JOHNSON
Entity Type:Organization
Organization Name:CRISSY M. JOHNSON
Other - Org Name:BABIES CAN'T WAIT
Other - Org Type:Other Name
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-426-8626
Mailing Address - Street 1:184 MOSSY OAK CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3093
Mailing Address - Country:US
Mailing Address - Phone:803-426-8626
Mailing Address - Fax:
Practice Address - Street 1:184 MOSSY OAK CIR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3093
Practice Address - Country:US
Practice Address - Phone:803-426-8626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003145394AMedicaid