Individual
MR. JACK FRANK JOHNSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
724 ARDEN LN, SUITE 100, ROCK HILL, SC 29732-2996
(803) 980-7337
(803) 980-2229
Mailing address
724 ARDEN LN, SUITE 100, ROCK HILL, SC 29732-2996
(803) 980-7337
(803) 980-2229
Taxonomy
Speciality
Code
Description
License number
State
364SP0200X
Pediatric Clinical Nurse Specialist
Primary
3360
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3360
SOUTH CAROLINA STATE LICENSE
SC
01
—
54-03360
SOUTH CAROLINA CONTROLLED SUBSTANCES CERTIFICATE OF REGISTRATION
SC
Enumeration date
06/04/2009
Last updated
06/04/2009
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