Individual
JACOB JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
413 SALVO CT, HOLLY RIDGE, NC 28445-8609
(573) 201-6504
Mailing address
413 SALVO CT, HOLLY RIDGE, NC 28445-8609
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
07/31/2020
Last updated
07/31/2020
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