Individual
BOTLHALE DORICA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1009 WHITLOW BLVD, SUMMERVILLE, SC 29483-5344
(843) 822-3605
Mailing address
1009 WHITLOW BLVD, SUMMERVILLE, SC 29483-5344
(843) 822-3605
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
05/20/2022
Last updated
05/20/2022
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