Individual
DEBRA M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2309 DUNEDIN DR APT 3, PETERSBURG, VA 23803-5475
(252) 281-0495
Mailing address
PO BOX 251, LUCAMA, NC 27851-0251
(252) 281-0495
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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