Provider Demographics
NPI:1780433144
Name:JOHNSON, PAMELA R
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
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 1:1120 S HIGH HILL PL APT A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-3859
Mailing Address - Country:US
Mailing Address - Phone:682-279-0690
Mailing Address - Fax:
Practice Address - Street 1:1120 S HIGH HILL PL APT A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-3859
Practice Address - Country:US
Practice Address - Phone:682-279-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service