Provider Demographics
NPI:1306187844
Name:JOHNSON, STACY L
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 S PALMERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-5402
Mailing Address - Country:US
Mailing Address - Phone:615-973-0034
Mailing Address - Fax:877-854-9228
Practice Address - Street 1:242 W MAIN ST # 177
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3318
Practice Address - Country:US
Practice Address - Phone:615-973-0034
Practice Address - Fax:877-854-9228
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other