Basic Information
| Provider Information | |||||||||
| NPI: | 1831259886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ARLENE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 457- B HWY 123 BYPASS | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648884464 | ||||||||
| FaxNumber: | 8648884462 | ||||||||
| Practice Location | |||||||||
| Address1: | 457- B HWY 123 BYPASS | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648884464 | ||||||||
| FaxNumber: | 8648884462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 06/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2711 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | GP1060 | 05 | SC | MEDICAID | RHC195 | 05 | SC | MEDICAID | 2711 | 01 | SC | LICENSE | OTHER |