Individual
ADA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
903 W MAIN ST, YADKINVILLE, NC 27055-7807
(336) 463-5510
Mailing address
8045 PEAK RD, CLEMMONS, NC 27012-9789
(336) 463-5510
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
2883
NC
Other
Enumeration date
02/16/2010
Last updated
02/16/2010
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