Individual
LORI ANNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1114 N MAIN ST, SUMMERVILLE, SC 29483-7326
(843) 212-8070
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2171
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2171
SC LICENSE
SC
Enumeration date
11/03/2014
Last updated
02/27/2025
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