Individual
MR. KYLE HARRIS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1910 BLANDING ST, COLUMBIA, SC 29201-3520
(803) 256-4107
(803) 253-6655
Mailing address
1910 BLANDING ST, COLUMBIA, SC 29201-3520
(803) 256-4107
(803) 253-6655
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1014
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0317PA
—
SC
Enumeration date
08/10/2005
Last updated
10/15/2007
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