Individual
JOHN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 CEDAR CREST DR, HUNTINGTON, WV 25705-3011
(304) 634-7516
Mailing address
1501 CEDAR CREST DR, HUNTINGTON, WV 25705-3011
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/18/2021
Last updated
02/18/2021
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