Individual
JIMMY WALLACE JOHNSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
706 PENNICK RD, BRUNSWICK, GA 31525-5310
(912) 275-7889
Mailing address
706 PENNICK RD, BRUNSWICK, GA 31525-5310
(912) 275-7889
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
07/29/2018
Last updated
07/29/2018
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