Idella Johnson PA-C

NPI 1073554523 - Physician Assistant - 363A00000X

NPI Details
NPI 1073554523
Gender Female
Enumeration Date 06/08/2006
Last Updated 12/16/2015
Entity Type Individual
Active Over 10 years ago
Practice Location
1610 TAZEWELL RD
SUITE 201
TAZEWELL TN, 37879-3600, US
Phone (423) 626-8393
Fax (423) 626-8749
Business Location
1610 TAZEWELL RD
SUITE 201
TAZEWELL TN, 37879-3600, US
Phone (423) 626-8393
Fax (423) 626-8749
Toxanomy
Taxonomy Code 363A00000X
License State Tennessee
License Number 670
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According to our database, Idella Johnson PA-C NPI is 1073554523, taxonomy code is 363A00000X and license number is 670, license state is located at Tennessee. Idella Johnson PA-C physically located at 1610 Tazewell Rd, Tazewell TN, 37879-3600. NPI Number Idella Johnson PA-C has the Individual type.

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1073554523 NPI number is provided on an as is basis without warranty of any kind. 1073554523 is maintained by the National Plan & Provider Enumeration System. The contents of Idella Johnson PA-C are for informational purposes only.