Provider Demographics
NPI:1629802293
Name:JOHNSON, TASHA LATONIA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:LATONIA
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:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-0302
Mailing Address - Country:US
Mailing Address - Phone:903-372-2988
Mailing Address - Fax:
Practice Address - Street 1:200008 CHAMPION FOREST DR SUITE 601
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:713-819-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty