Individual
JENNIFER L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9699 OCEAN HWY, PAWLEYS ISLAND, SC 29585-7425
(843) 237-4296
(843) 237-0495
Mailing address
PO BOX 1209, MURRELLS INLET, SC 29576-1209
(843) 652-8220
(843) 527-7080
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A1133
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A1133
STATE MEDICAL LICENSE
SC
Enumeration date
09/15/2006
Last updated
07/23/2015
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