Individual
JOHAN HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3600 FOREST DR STE 300, COLUMBIA, SC 29204-4057
(803) 749-5101
(803) 933-3045
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29031
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290312
—
SC
01
—
AA38422353
MEDICARE PTAN
SC
Enumeration date
03/16/2007
Last updated
07/13/2020
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