Provider Demographics
NPI:1023346525
Name:JOHNSON, THOMAS J (OPP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 STROZIER CT
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-2035
Mailing Address - Country:US
Mailing Address - Phone:479-739-7720
Mailing Address - Fax:
Practice Address - Street 1:1311 STROZIER CT
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2035
Practice Address - Country:US
Practice Address - Phone:479-739-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00096246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other