Provider Demographics
NPI:1912473141
Name:JOHNSON, TAWANA RENATA (CBD, CPPD)
Entity Type:Individual
Prefix:
First Name:TAWANA
Middle Name:RENATA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CBD, CPPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 PLANTERS KNLS
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-8576
Mailing Address - Country:US
Mailing Address - Phone:843-560-9197
Mailing Address - Fax:
Practice Address - Street 1:8320 PLANTERS KNLS
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-8576
Practice Address - Country:US
Practice Address - Phone:843-560-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula