Individual
TABITHA ANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
104 GEORGE BISHOP PKWY, MYRTLE BEACH, SC 29579-7335
(800) 805-6989
Mailing address
5006 WATERGATE DR, MYRTLE BEACH, SC 29588-6320
(203) 584-2719
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
54146
SC
Other
Enumeration date
12/13/2022
Last updated
12/13/2022
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