Provider Demographics
NPI:1871202283
Name:JOHNSON, AUNDREA
Entity type:Individual
Prefix:
First Name:AUNDREA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 MICHIGAN AVENUE RD NE APT 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-5484
Mailing Address - Country:US
Mailing Address - Phone:423-310-1240
Mailing Address - Fax:
Practice Address - Street 1:2933 MICHIGAN AVENUE RD NE APT 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-5484
Practice Address - Country:US
Practice Address - Phone:423-310-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist