Individual
MS. HEATHER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 REGISTER ST, CHARLESTON, SC 29405-2421
(438) 308-9662
Mailing address
1050 REGISTER ST, NORTH CHARLESTON, SC 29405-2421
(843) 308-9662
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1383105133
MILITARY
—
Enumeration date
04/25/2014
Last updated
09/29/2021
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