Individual
MARY LILLIAN DOLAN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2403 ALLISON RD, BEAUFORT, SC 29902-5923
(843) 524-1078
Mailing address
2403 ALLISON RD, BEAUFORT, SC 29902-5923
(843) 524-1078
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
37676
SC
390200000X
Student in an Organized Health Care Education/Training Program
5101021066
MI
Other
Enumeration date
06/11/2014
Last updated
07/21/2022
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