1508942962 NPI number — MRS. RENEE STONE JOHNSON PTA

Table of content: MRS. RENEE STONE JOHNSON PTA (NPI 1508942962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508942962 NPI number — MRS. RENEE STONE JOHNSON PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
RENEE
Provider Middle Name:
STONE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508942962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 EAGLE CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-597-4269
Provider Business Mailing Address Fax Number:
931-506-5065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 OAK PARK DR
Provider Second Line Business Practice Location Address:
NHC REHAB
Provider Business Practice Location Address City Name:
MCMINNVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-473-6039
Provider Business Practice Location Address Fax Number:
931-506-5065
Provider Enumeration Date:
10/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  PTA0000002567 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)