Provider Demographics
NPI:1780845123
Name:VERNA M. JOHNSON
Entity Type:Organization
Organization Name:VERNA M. JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRIVER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERNA
Authorized Official - Middle Name:MONTGOMERY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-458-0668
Mailing Address - Street 1:128 RUE MAX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-2342
Mailing Address - Country:US
Mailing Address - Phone:850-458-0668
Mailing Address - Fax:
Practice Address - Street 1:128 RUE MAX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-2342
Practice Address - Country:US
Practice Address - Phone:850-458-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle