Individual
MRS. PORTIA LYNETT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
814 ORLANDO CT, ROANOKE, VA 24019-5308
(540) 793-7670
Mailing address
814 ORLANDO CT, ROANOKE, VA 24019-5308
(540) 793-7670
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T23958975
VA
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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