Provider Demographics
NPI:1538480819
Name:JOHNSON, CAROL (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 WAYNESBORO HWY
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-6200
Mailing Address - Country:US
Mailing Address - Phone:580-603-1733
Mailing Address - Fax:580-603-1733
Practice Address - Street 1:467 WAYNESBORO HWY
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-6200
Practice Address - Country:US
Practice Address - Phone:580-603-1733
Practice Address - Fax:580-603-1733
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN140162163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care