Individual
MR. JERRY LYNN JOHNSTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
WOMACK ARMY MEDICAL CENTER, MCXC-COD, CREDENTIALS OFFICE, ATTN: SHEILA BLACKWELL, FORT BRAGG, NC 28310-0001
(910) 907-8922
Mailing address
3865 TIMBERSTREAM DR, SOUTHPORT, NC 28461-9023
(910) 454-8686
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
104108
NC
Other
Enumeration date
02/08/2006
Last updated
07/08/2007
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