Provider Demographics
NPI:1174777932
Name:JOHNSON, TAMECA LAZELL (LMT, MMP)
Entity type:Individual
Prefix:MS
First Name:TAMECA
Middle Name:LAZELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:TRANQUIL
Other - Middle Name:
Other - Last Name:ESCAPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THERAPEUTIC SERVICES
Mailing Address - Street 1:215 PEBBLESTUMP PT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1619
Mailing Address - Country:US
Mailing Address - Phone:404-452-9326
Mailing Address - Fax:
Practice Address - Street 1:220 LANIER AVE E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1604
Practice Address - Country:US
Practice Address - Phone:404-452-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist