Individual
JAYVIAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2116 E 11TH ST, LITTLE ROCK, AR 72202-4320
(501) 425-8174
Mailing address
PO BOX 166415, LITTLE ROCK, AR 72216-6415
(501) 425-8174
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
46-0763339
AR
Other
Enumeration date
05/06/2016
Last updated
05/06/2016
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