Individual
JOHNNY ROGER TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 W OGLETHORPE HWY, HINESVILLE, GA 31313
(912) 334-0524
(508) 355-0524
Mailing address
PO BOX 1084, GLENNVILLE, GA 30427-1084
(912) 334-0524
(508) 355-0524
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
Primary
MSW001177
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001177
2273
GA
Enumeration date
02/20/2020
Last updated
07/25/2023
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