Provider Demographics
NPI:1326595349
Name:JOHNSON, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
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 1:1010 COMMON ST STE 500
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2467
Mailing Address - Country:US
Mailing Address - Phone:504-302-1323
Mailing Address - Fax:504-324-4573
Practice Address - Street 1:1010 COMMON ST STE 500
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2467
Practice Address - Country:US
Practice Address - Phone:504-302-1323
Practice Address - Fax:504-324-4573
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker