Individual
JORDAN REID JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
191 MAIN ST, BANNER ELK, NC 28604-9626
(828) 898-8892
Mailing address
PO BOX 128, BANNER ELK, NC 28604-0128
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3602
NC
Other
Enumeration date
10/19/2017
Last updated
10/19/2017
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