Provider Demographics
NPI:1447617766
Name:HALE-JOHNSON, PARIS
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:
Last Name:HALE-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 1:14913 STONEY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5567
Mailing Address - Country:US
Mailing Address - Phone:313-622-3142
Mailing Address - Fax:
Practice Address - Street 1:14913 STONEY BROOK DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-5567
Practice Address - Country:US
Practice Address - Phone:313-622-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other