Provider Demographics
NPI:1811230485
Name:JOHNSON, TAMARA W (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5942 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2258
Mailing Address - Country:US
Mailing Address - Phone:804-647-3162
Mailing Address - Fax:
Practice Address - Street 1:5942 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2258
Practice Address - Country:US
Practice Address - Phone:804-647-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management