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Individual

ANGELA JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
100 N PATTERSON ST, VALDOSTA, GA 31601-5570
(866) 773-8033
Mailing address
100 N PATTERSON ST, VALDOSTA, GA 31601-5570
(866) 773-8033

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
048856782
GA

Other

Enumeration date
01/16/2025
Last updated
01/16/2025
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