Individual
LAURA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 GLYNCO PKWY, SUITE 400, BRUNSWICK, GA 31525-7921
(912) 265-1357
(912) 265-0495
Mailing address
1111 GLYNCO PKWY, SUITE 400, BRUNSWICK, GA 31525-7921
(912) 265-1357
(912) 265-0495
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004660
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004660
STATE LICENSE
GA
Enumeration date
04/10/2007
Last updated
06/08/2011
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