Individual
MR. RICHARD C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2829 E HIGHWAY 76, MULLINS, SC 29574-6035
(843) 431-2542
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
101
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN0882
—
SC
01
—
P00621218
RR MEDICARE
SC
Enumeration date
06/14/2006
Last updated
09/29/2011
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