Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 8219 | NC |
Y | 213EG0000X | General Practice | 8219 | NC |
NPI | 1003914557 |
---|---|
Provider Name | Tamatha Lynn Johnson |
First Address | Dover, NH 03820-2454 |
Second Address | Dover, NH 03820-2454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/06/2011 |