Individual
MRS. JENNIFER GAIL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
130 E BROAD ST, CAMILLA, GA 31730-1809
(229) 336-1115
(229) 336-1151
Mailing address
6105 OLD NEWTON RD, CAMILLA, GA 31730-5404
(229) 403-7994
(229) 336-1151
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002442
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA002442
STATE OF GEORGIA
GA
Enumeration date
09/30/2015
Last updated
09/30/2015
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