Johnson Diagnostic LLC
Organization Active NPI In Home Supportive Care Agency · Purvis, MS
NPI 1477448249 · NPPES record last updated Jun 11, 2025
Key facts
- NPI
- 1477448249
- Entity type
- Organization (NPI type 2)
- Primary specialty
- In Home Supportive Care Agency 253Z00000X
- Legal business name
- JOHNSON DIAGNOSTIC LLC
- Practice address
- 121 Front Street
Purvis, MS 39475 - Phone
- (833) 385-3874
- Fax
- (601) 861-4433
- NPI assigned
- Jun 11, 2025
- Organization subpart
- Yes
- Parent organization (as reported)
- JOHNSON DIAGNOSTIC LLC
Authorized official
- Name
- Wankethia Johnson
- Title
- Ceo
- Phone
- (833) 385-3874
Corporate family (same tax ID) 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2328565 | Johnson Diagnostic Services LLC | Certificate of waiver | Aug 11, 2027 |
National Provider Directory
- Tax ID family
- Johnson Diagnostic LLC
- Part of
- Johnson Diagnostic LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | |||
| Home Health Agency | 251E00000X | |||
| Home Infusion Agency | 251F00000X | |||
| Nursing Care Agency | 251J00000X | |||
| In Home Supportive Care Agency | 253Z00000X | Yes | ||
| Non-emergency Medical Transport (VAN) | 343900000X | |||
| Respite Care | 385H00000X |
Addresses
Primary practice location
121 Front Street
Purvis, MS 39475
Mailing address
121 Front Street
Purvis, MS 39475
Phone (833) 385-3874
Other names
- Divine Home Care Services
Other providers in Purvis, MS
- McKenzie Irish
- Elizabeth Jackson
- Josalin Jackson
- James W. Moore, III
- Johns' Discount Drugs, Inc.
- Melinda Kay Jones
- Markita Jordan
- Kristina Keown
- Garland W King Jr.
- Lamar County School Clinic
All providers in Purvis, MS · In Home Supportive Care Agency in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.