Individual
JESSICA LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11082 N RADIO STATION RD, SENECA, SC 29678
(864) 882-2314
(843) 882-3677
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8611
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36682
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
366820
—
SC
Enumeration date
02/20/2014
Last updated
02/07/2024
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