| Doctor Name: | TRACIE JOHNSON |
| NPI Number: | 1215357074 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 207250 |
| Business Practice Address: | 905 W Greenwood St Abbeville, SC - 296205678 |
| Business Phone Number: | 8643662131 |
| Business Fax Number: | |
| Mailing Address: | 905 W Greenwood St, ABBEVILLE |
| State: | SC |
| Postal Code: | 296205678 |
| Phone Number: | 8643662131 |
| Fax Number: | |
| NPI Enumeration Date: | 04/21/2014 |
| NPI Last Update Date: | 04/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 207250 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |