Individual
WANDA BRESHAE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
506 MANCHESTER EXPY STE A13, COLUMBUS, GA 31904-6483
(706) 653-9343
Mailing address
919 LAWYERS LN, COLUMBUS, GA 31906-3129
(706) 653-9242
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
12/31/2019
Last updated
12/31/2019
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