Individual
KETTY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1016 EUCLID AVE, CHARLOTTE, NC 28203-4520
(704) 807-5699
(704) 631-4574
Mailing address
1016 EUCLID AVE, CHARLOTTE, NC 28203-4520
(704) 807-5699
(704) 631-4574
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NC
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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