Organization
EMERALD COAST REGEN, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY JOHNSON (PRESIDENT)
(850) 814-7686
Entity
Organization
Contact information
Practice address
1008 JENKS AVE, PANAMA CITY, FL 32401-2437
(850) 814-7686
Mailing address
1008 JENKS AVE, PANAMA CITY, FL 32401-2437
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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