Individual
KENNETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
115 SPRING GLENN CT, ROCKY MOUNT, NC 27803-8010
(252) 469-9363
Mailing address
115 SPRING GLENN CT, ROCKY MOUNT, NC 27803-8010
(252) 469-9363
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
000022128241
NC
Other
Enumeration date
08/19/2021
Last updated
08/19/2021
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