Individual
MR. DERMAINE ANTWAN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CERTIFIED HAIR LOSS
Contact information
Practice address
3500 HIGHWAY 39 N APT 77, MERIDIAN, MS 39301-1339
(334) 505-7628
Mailing address
3500 HIGHWAY 39 N APT 77, MERIDIAN, MS 39301-1339
(334) 505-7628
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
5055
MS
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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