Individual
NOAH DEWAYNE JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
11707 KINGSTON DR, BATON ROUGE, LA 70807-2066
(225) 302-3049
Mailing address
11707 KINGSTON DR, BATON ROUGE, LA 70807-2066
(225) 302-3049
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
005862169
LA
Other
Enumeration date
03/05/2019
Last updated
03/05/2019
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