Individual
CHARLES WADE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(605) 347-7491
Mailing address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(605) 347-7491
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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