Gaby Laverne Johnson

Individual provider Active NPI Early Intervention Provider Agency · Shaw, MS

NPI 1043090194 · NPPES record last updated Oct 4, 2023

Key facts

NPI
1043090194
Entity type
Individual (NPI type 1)
Primary specialty
Early Intervention Provider Agency 252Y00000X
Practice address
32 Shaw Skene Rd
Shaw, MS 38773-9502
Phone
(662) 721-6438
NPI assigned
Oct 4, 2023
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X MS Yes

Addresses

Primary practice location

32 Shaw Skene Rd
Shaw, MS 38773-9502

Mailing address

PO Box 747
Boyle, MS 38730-0747
Phone (662) 721-6438

Other providers in Shaw, MS

All providers in Shaw, MS · Early Intervention Provider Agency in Mississippi

Sources for this page

Verify at the official NPI Registry.