Individual
ROGER DALTON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 395-2200
(803) 395-2304
Mailing address
PO BOX 1245, ORANGEBURG, SC 29116-1245
(803) 395-4497
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
100263
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
17516
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2825
—
SC
Enumeration date
04/27/2011
Last updated
11/09/2020
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