Provider Demographics
NPI:1598369365
Name:JOHNSON, CALTHEDRA LANEE
Entity type:Individual
Prefix:MRS
First Name:CALTHEDRA
Middle Name:LANEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CALTHEDRA
Other - Middle Name:LANEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CALTHEDRA RELIABLE S
Mailing Address - Street 1:5551 OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3038
Mailing Address - Country:US
Mailing Address - Phone:251-786-6648
Mailing Address - Fax:
Practice Address - Street 1:1253 SKIPPER DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5649
Practice Address - Country:US
Practice Address - Phone:251-786-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health