Provider Demographics
NPI:1457801136
Name:JOHNSON, SARAI
Entity Type:Individual
Prefix:DR
First Name:SARAI
Middle Name:
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 1:542 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LORMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39096-7002
Mailing Address - Country:US
Mailing Address - Phone:601-597-9191
Mailing Address - Fax:
Practice Address - Street 1:1644 B CARTER STREET SUITE 2
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373
Practice Address - Country:US
Practice Address - Phone:318-414-3065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health