Individual
JONATHON D DEPORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
TLLP
Contact information
Practice address
2175 ROCK MERRIT AVE, FORT LIBERTY, NC 28310-5000
(910) 907-7698
Mailing address
2175 ROCK MERRIT AVE, FORT LIBERTY, NC 28310-5000
(910) 907-7698
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/05/2024
Last updated
09/05/2024
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