Provider Demographics
NPI:1023511300
Name:JOHNSON-HAMMOND, GENITA LASHONDA
Entity type:Individual
Prefix:
First Name:GENITA
Middle Name:LASHONDA
Last Name:JOHNSON-HAMMOND
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 1:7071 ANISETREE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-5694
Mailing Address - Country:US
Mailing Address - Phone:901-649-4694
Mailing Address - Fax:
Practice Address - Street 1:4565 QUINCE RD
Practice Address - Street 2:1B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117
Practice Address - Country:US
Practice Address - Phone:901-649-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management