Shanta Marie Johnson, CCMA
Individual provider Active NPI Home Health Agency · Centerpoint, AL
NPI 1548751340 · NPPES record last updated Apr 30, 2024
Key facts
- NPI
- 1548751340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 18023894 (AL)
- Practice address
- 113 22ND Avenue SW
Centerpoint, AL 35215 - Phone
- (850) 737-7392
- NPI assigned
- May 29, 2018
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000000000 | AL | MD | Emergency Medicine Physician |
| 18023894 | AL | MD | Home Health Agency |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | |||
| Home Health Aide |
374U00000X | 18023894 | AL | |
| Home Health Aide | 374U00000X | 000000000 | AL | |
| Home Health Agency | 251E00000X | 18023894 | AL | Yes |
Addresses
Primary practice location
113 22ND Avenue SW
Centerpoint, AL 35215
Mailing address
113 22ND Ave NE
Center Point, AL 35215-4607
Phone (850) 737-7392
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 824882016 | Medicaid | AL |
Other names
- Mrs. Shanta Marie Johnson
Other providers in Centerpoint, AL
All providers in Centerpoint, AL · Home Health Agency in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.