Doctor Name: | MR. GRANT EDWARD JOHNSON |
NPI Number: | 1225451370 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 008591754 |
Business Practice Address: | 1221 Hilltop St Gibsland, LA - 71028 |
Business Phone Number: | 3188436090 |
Business Fax Number: | 3188436090 |
Mailing Address: | P O Box 423, 1221 Hilltop St GIBSLAND |
State: | LA |
Postal Code: | 71028 |
Phone Number: | 3188436090 |
Fax Number: | 3188436090 |
NPI Enumeration Date: | 01/27/2014 |
NPI Last Update Date: | 01/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 172A00000X |
License Number: | 008591754 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Driver |
Taxonomy Specialization: | |
Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |