Individual
MITCHELL WAYNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 KINCAID ST, KINGSPORT, TN 37660-1420
(423) 360-8990
Mailing address
300 KINCAID ST, KINGSPORT, TN 37660-1420
(423) 360-8990
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
—
Other
Enumeration date
03/08/2010
Last updated
03/08/2010
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