Organization Name: | CJ MEDICAL LLC CANDACE JOHNSON |
NPI Number: | 1629340799 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CANDACE JOHNSON (OWNER) |
Mailing Address: | 12095 Steekee School Rd Loudon |
State: | TN US |
Postal Code: | 377744565 |
Phone Number: | 8654583290 |
Fax Number: | |
NPI Enumeration Date: | 02/03/2012 |
NPI Last Update Date: | 02/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2100X |
License Number: | 16163 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Acute Care |
Taxonomy Definition: |