Provider Demographics
NPI:1831259886
Name:JOHNSON, ARLENE ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457- B HWY 123 BYPASS
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678
Mailing Address - Country:US
Mailing Address - Phone:864-888-4464
Mailing Address - Fax:864-888-4462
Practice Address - Street 1:457- B HWY 123 BYPASS
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-888-4464
Practice Address - Fax:864-888-4462
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2711208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1060Medicaid
SCRHC195Medicaid
SC2711OtherLICENSE