Individual
KRYSTLE ELIZABETH AMELIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1108 WHITEHALL ST, JACKSON, TN 38301-3730
(731) 410-7161
Mailing address
1108 WHITEHALL ST, JACKSON, TN 38301-3730
(731) 410-7161
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12104
TN
Other
Enumeration date
05/22/2019
Last updated
01/19/2023
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