Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 3061 | NC |
NPI | 1336366228 |
---|---|
Provider Name | Dr. Tawana Johnson |
First Address | Greensboro, NC 27402-1915 |
Second Address | Greensboro, NC 27408-8042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 10/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89085JY | (05) | NC |
U92159 | (02) | NC |