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Individual

MR. KENNETH RAY JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1203 TOWN PARK LN, EVANS, GA 30809
(706) 650-7546
(706) 922-9168
Mailing address
PO BOX 63185, CHARLOTTE, NC 28263-3001
(706) 650-7546
(706) 922-9168

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
6259
GA
363AS0400X
Surgical Physician Assistant
Primary
6259
GA

Other

Enumeration date
09/19/2011
Last updated
06/29/2018
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