Individual
MRS. CARELLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
158 KIOWA DR S, JESUP, GA 31545
(912) 424-3204
Mailing address
158 KIOWA DR S, JESUP, GA 31545
(912) 424-3204
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
CN0036020198
GA
Other
Enumeration date
03/04/2025
Last updated
03/04/2025
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