Individual
LOGAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10652 S EASTERN AVE, SUITE A, HENDERSON, NV 89052-4952
(702) 476-2800
(702) 476-2040
Mailing address
PO BOX 743752, ATLANTA, GA 30374-3752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0313
NV
Other
Enumeration date
04/15/2015
Last updated
02/12/2019
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