Martine Patrice Johnson | Memphis, TN • PECOS Search

Martine Patrice Johnson

Social Worker

Behavioral Health & Social Service Providers

1030 Jefferson Avenue, Memphis, TN 38104

(901) 523-8990 (901) 870-1864

PECOS Enrollment

Based on the most recent information from CMS, provider Martine Patrice Johnson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1003526823
Provider Type
Individual
Full Name
Johnson, Martine Patrice
Title
Mrs.
Credential
LMSW

Gender
Female
Sole Proprietor
No
Enumeration Date
12/2/2022
Last Updated
12/2/2022

Contact Information

Practice Location

1030 Jefferson Avenue, Memphis, TN 38104

Unlisted Fax

Mailing Location

1930 Holly Springs Road, Hernando, MS 38632

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License M10380 Mississippi