Provider Demographics
NPI:1053516286
Name:JOHNSON, RAYAR
Entity type:Individual
Prefix:MS
First Name:RAYAR
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RAYAR
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1558
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-1558
Mailing Address - Country:US
Mailing Address - Phone:601-648-9211
Mailing Address - Fax:
Practice Address - Street 1:20 JR MERRILL RD
Practice Address - Street 2:
Practice Address - City:BUCKATUNA
Practice Address - State:MS
Practice Address - Zip Code:39322-9502
Practice Address - Country:US
Practice Address - Phone:601-648-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS54276247200000X
MS347C00000X, 343900000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered171W00000XOther Service ProvidersContractor