Provider Demographics
NPI:1780873166
Name:STAGGS, JOHNNY WINFRED
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:WINFRED
Last Name:STAGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 HIGHWAY 100
Mailing Address - Street 2:APT 8
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-1199
Mailing Address - Country:US
Mailing Address - Phone:931-994-2812
Mailing Address - Fax:
Practice Address - Street 1:115 DYER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4551
Practice Address - Country:US
Practice Address - Phone:931-560-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor