Individual
JOHNATHAN LEON WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7445 ROBINSON FERRY RD, WHITE PLAINS, VA 23893-2101
(434) 378-3070
Mailing address
7445 ROBINSON FERRY RD, WHITE PLAINS, VA 23893-2101
(434) 378-3070
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T69512711
VA
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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