| NPI | 1184011835 |
|---|---|
| Former Name | KHAISHA VERDELLE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000057747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 57747) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2023-07-23 |