Provider Demographics
NPI:1750096327
Name:JOHNSON, SHAMICA LONETTE
Entity type:Individual
Prefix:
First Name:SHAMICA
Middle Name:LONETTE
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 1:250 SUN TEMPLE DR STE C5
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-5925
Mailing Address - Country:US
Mailing Address - Phone:253-325-5023
Mailing Address - Fax:256-325-5026
Practice Address - Street 1:250 SUN TEMPLE DR STE C5
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-5925
Practice Address - Country:US
Practice Address - Phone:253-325-5023
Practice Address - Fax:256-325-5026
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care