Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080A0000X | Adolescent Medicine | 053565 | GA |
Y | 2080A0000X | Adolescent Medicine | 37230 | TN |
NPI | 1104878164 |
---|---|
Provider Name | Dr. Rhonda Charlene Johnson |
First Address | Memphis, TN 38103-2807 |
Second Address | Memphis, TN 38127-5829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 25/05/2011 |