MARTEZ ANTONIO JOHNSON NPI 1205075637

NPI Information

NPI: 1205075637
Provider Name: MARTEZ ANTONIO JOHNSON

Doing Business As: EXCELCARE REHABILITATION SERVICES

Classification: Clinic/Center - 261QH0700X
Entity Type: Organization

Specialization: Hearing and Speech

Address:
3751 BISHOP AVE
JACKSON, MS
ZIP 39213
Phone: (601) 605-2313
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MARTEZ ANTONIO JOHNSON is a hearing and speech clinic center in Jackson, MS. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, prescriptive, and therapy services related to congenital and acquired conditions and diseases that affect hearing capacity and speech ability. MARTEZ ANTONIO JOHNSON NPI is 1205075637. The provider is registered as an organization entity type.
The provider Is Doing Business As Excelcare Rehabilitation Services.

The provider's business location address is:

3751 BISHOP AVE
JACKSON, MS
ZIP 39213-017
Phone: (601) 605-2313

The provider's authorized official is Martez Antonio Johnson .
The authorized official title is Owner and has the following contact phone number (601) 605-2313.

The enumeration date for this NPI number is 2/9/2009 and was last updated on 2/9/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0700X	Clinic/Center	Hearing and Speech			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	APPLIED FOR	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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