Provider Demographics
NPI:1417378415
Name:JOHNSON, TEMPERESS
Entity Type:Individual
Prefix:
First Name:TEMPERESS
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:PO BOX 177
Mailing Address - Street 2:72 CLEBORNE STREET
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-0177
Mailing Address - Country:US
Mailing Address - Phone:229-732-3981
Mailing Address - Fax:
Practice Address - Street 1:72 CLEBORNE STREET
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840
Practice Address - Country:US
Practice Address - Phone:229-732-3981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion