Provider Demographics
NPI:1639838527
Name:JOHNSON, SARAH MAY
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MAY
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 1:102 BEVERLEY ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3843
Mailing Address - Country:US
Mailing Address - Phone:304-923-2031
Mailing Address - Fax:
Practice Address - Street 1:206 MAPLE RD.
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:WV
Practice Address - Zip Code:25839
Practice Address - Country:US
Practice Address - Phone:304-923-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant