Individual
LA-KENYA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
148 COOK RD, MOULTRIE, GA 31788-1475
(229) 456-2772
Mailing address
162 COOK RD UNIT D, MOULTRIE, GA 31788-0948
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
GA
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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