Basic Information
| Provider Information | |||||||||
| NPI: | 1083123376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | RASHAUN | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123511529 | ||||||||
| FaxNumber: | 9522853980 | ||||||||
| Practice Location | |||||||||
| Address1: | 2475 VILLAGE DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | KINGSLAND | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315486729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123395499 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2017 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HADS000980 | GA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.