Individual
JOHNATHAN DONALD DEBETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4350 US 421 S, LILLINGTON, NC 27546-6760
(910) 893-1210
Mailing address
10118 KNOTTY PINE LN, RALEIGH, NC 27617-8218
(631) 678-8049
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-11534
NC
Other
Enumeration date
04/16/2021
Last updated
12/07/2021
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