Most Relevant Information
Provider Data
| NPI Number: | 1003526823 |
| Provider Name: | MARTINE PATRICE JOHNSON LMSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | M10380 |
Most Important Dates
| Enumeration Date: | 12/02/2022 |
| Last Updated: | 12/02/2022 |
Provider Practice Location
1030 JEFFERSON AVENUE
MEMPHIS
TN
38104
Practice Location Phone/Fax
| Phone: | 9015238990 |
| Fax: |
Provider Mailing Location
1930 HOLLY SPRINGS ROAD
HERNANDO
MS
38632
Provider Mailing Phone/Fax
| Phone: | 9018701864 |
| Fax: |