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Individual

JUDY DYER JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
391 SERPENTINE DR STE 400, SPARTANBURG, SC 29303-3081
(864) 560-7517
(864) 560-7520
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
28543
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
301100
SC
05
NN0227
SC
01
SCT0517652
MEDICARE PIN
SC
Enumeration date
12/18/2017
Last updated
08/13/2024
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