Provider Demographics
NPI:1003558743
Name:JOHNSON, EDWARD JOSEPH III
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSEPH
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-2115
Mailing Address - Country:US
Mailing Address - Phone:504-516-0636
Mailing Address - Fax:
Practice Address - Street 1:2601 TULANE AVE STE 300
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7499
Practice Address - Country:US
Practice Address - Phone:504-570-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator